Subclinical pulmonary vein narrowing after ablation for atrial fibrillation

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 relation between the intensity of radiofrequency ablation and PV size changes was assessed by standard correlation and by comparing those PVs that received more than the median number of radiofrequency ablations with those that received fewer than or equal to the median.