Korean Circ J.  2017 Jul;47(4):528-531. 10.4070/kcj.2016.0382.

Controlled Atrial Fibrillation after Pulmonary Vein Stenting

• Park YA
• Seo J
• Pak HN

• KMID: 2392892
• DOI: http://doi.org/10.4070/kcj.2016.0382

Abstract

When there is no pulmonary vein reconnection after catheter ablation for atrial fibrillation, patients can experience recurrence of atrial fibrillation without clear evidence of non-pulmonary vein foci. We describe a patient with significant pulmonary vein stenosis and recurrent atrial fibrillation after four ablation procedures. After successful pulmonary vein stenting, the symptoms were resolved, and sinus rhythm was maintained for 2 years without treatment with antiarrhythmic medication. We believe pulmonary vein stenting potentially controlled atrial fibrillation by providing pulmonary vein pressure relief or by compressing the epicardial triggers occurring at the pulmonary vein ostium.

Keyword

Atrial fibrillation; Catheter ablation; Balloon angioplasty

MeSH Terms

Angioplasty, Balloon
Atrial Fibrillation*
Catheter Ablation
Constriction, Pathologic
Humans
Pulmonary Veins*
Recurrence
Stents*
Veins

Figure

• 

  Fig. 1 Electroanatomical map and CT images. (A) 3D-CT merged NavX electroanatomical map of the 3rd AF catheter ablation (2 years prior). (B) Five months after the last ablation procedure, severe stenosis of the left superior PV was observed (white arrows). (C) Twelve-month follow-up CT after PV stenting. 3D: 3-dimensional, CT: computed tomography, PV: pulmonary vein.

• 

  Fig. 2 Image diagnosis of PV stenosis and PV stenting. (A, B) A transesophageal echocardiogram shows increased PV systolic flow velocity in the pulse wave Doppler and turbulent flow at the PV ostium in the color Doppler. (C, D) Left superior PV venograms before (C) and after (D) angioplasty. PV: pulmonary vein.

• 

  Fig. 3 Tachogram from a 24-month follow-up Holter after PV stenting. There were no episodes of AF after the PV stenting. A single peak at 16:35 in the tachogram (arrow) was a transient non-sustained atrial tachycardia with 12 consecutive beats. BPM: beats per minute, PV: pulmonary vein, AF: atrial fibrillation.

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