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2013 BOSTON ATRIAL FIBRILLATION SYMPOSIUM

Focus on Stenosis

Inflammation and scarring or occlusion of the PV Opening after Ablation

by Steve S. Ryan, PhD

Dr. Douglas Packer from the Mayo Clinic, in a presentation on the Risks of A-Fib Ablation, discussed stenosis (a narrowing of blood vessels after A-Fib ablation)—a complication considered to be increasingly uncommon as ablation techniques have improved over the years.  But Mayo, as a nationally recognized A-Fib center, is often sent cases with “exotic” complications. Stenosis is seen more often than one would expect.

Dr. Packer stressed that A-Fib doctors need to be vigilant and should check ablated patients for stenosis after three months. (It usually takes six months for a severe case of stenosis to completely close a vein.) But only around 25% of A-Fib doctors really look for stenosis. If a patient has any significant pulmonary problems, from bronchitis to coughing up blood, complains of shortness of breath, develops pneumonia, etc., suspect stenosis unless proven otherwise. If caught early, angioplasty balloons and stents can often correct for stenosis. But these patients need to be re-checked probably for life, because re-stenosis can occur.

In good news for patients suffering from stenosis, Dr. Packer added that in Mayo’s experience, in many cases of complete stenosis or blockage, collaterals formed within two years. (Collaterals are new Pulmonary Veins that develop to replace the veins closed off by stenosis.) “The real issue is whether that is good enough to reduce symptoms. It depends largely on what the other vein on that side looks like. If it is also occluded, patients may remain very symptomatic.”

Among other complications, Mayo is also seeing:

      • Cases of stiff left atrium, presumably because of excessive scarring of the left atrium.
      • MRI studies have revealed Cerebral Micro Embolic events, but they don’t always cause symptoms and often disappear over time.  But they are certainly something everyone wants to avoid causing.
      • Phrenic Nerve injury during CryoBalloon ablation usually goes away over time and is less of a problem with experience.
      •  Dr. Packer also mentioned “late tamponade” (an accumulation of fluid in the pericardial sac around the heart) probably due to oozing from an ablation or catheter site that recurs when patients are started back on anticoagulants.

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Last updated: Thursday, April 25, 2013

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