Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation ― A Computed Tomography-Based Analysis of Incidence and Risk Factors ―

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BACKGROUND: The true incidence of pulmonary vein (PV) stenosis after radiofrequency (RF) ablation for atrial fibrillation remains uncertain because routine imaging surveillance is not universally performed and many cases of PV stenosis are asymptomatic. METHODS AND RESULTS: This single-center retrospective study included atrial fibrillation ablation procedures with both pre- and postprocedural (based on clinical indication) cardiac computed tomography (CT) imaging ≥30 days after ablation. PV stenosis was defined as ≥50% luminal reduction and classified as moderate (50-89%), severe (90-98%), or complete (≥99%) occlusion. Among 303 RF procedures in 242 patients, PV stenosis occurred in 49 (16%) procedures, and severe stenosis or occlusion in 28 (9.2%), mostly asymptomatic. Although the overall incidence did not differ between high-power strategies, severe stenosis was more frequently observed with temperature-controlled RF catheters under very high-power, short-duration settings. No PV stenosis was observed after pulsed field ablation. CONCLUSIONS: In this CT-enriched cohort, the incidence of PV stenosis after RF ablation was higher than previously reported symptomatic rates, largely reflecting improved detection of subclinical PV injury. Specific catheter-energy combinations may be associated with severe PV stenosis. These findings suggest that not all high-power strategies are equivalent and that the interaction between the energy delivery profile and catheter technology may influence the risk of clinically significant PV injury. Procedural optimization and risk-adapted imaging follow-up may help mitigate PV-related complications.

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