Subclinical pulmonary vein narrowing after ablation for atrial fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The recognition that paroxysmal AF may be initiated by abnormalities in the pulmonary veins (PVs) led to the development of catheter based radiofrequency ablation procedures to isolate the PV and prevent the recurrence of AF.1 Clinical PV stenosis is recognised as an uncommon but severe complication.2 Contrast enhanced three dimensional magnetic resonance angiography (CE-MRA)3 readily visualises the PV and may detect changes in PV size before the development of clinical stenosis.4 We measured in detail the PV diameter, perimeter, and cross sectional area (CSA) in a consecutive series of patients who underwent CE-MRA before and one month after AF ablation. The study cohort consisted of 23 consecutive patients with paroxysmal AF who underwent CE-MRA before and after AF ablation from October 2001 to May 2003. The study was approved by the hospital committee on clinical investigation. AF ablation was performed by a standard method5 with mapping of the left atrium and PV by the CARTO system (Biosense Webster Inc, Diamond Bar, California, USA). The PV maximum diameter, perimeter, and CSA were measured before and after the procedure by an observer blinded to the clinical treatment.3 The left atrial dimension was measured in the axial plane. Continuous variables are presented as …