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Pulmonary Vein Total Occlusion Following Catheter Ablation for Atrial Fibrillation

Clinical Implications After Long-Term Follow-Up

Luigi Di Biase, MD^_*,,1, Tamer S. Fahmy, MD^_*, Oussama M. Wazni, MD^_*, Rong Bai, MD^_*,,1, Dimpi Patel, MD^_*, Dhanunjaya Lakkireddy, MD^_*, Jennifer E. Cummings, MD^_*, Robert A. Schweikert, MD^_*, J. David Burkhardt, MD^_*, Claude S. Elayi, MD^_*, Mohamed Kanj, MD^_*, Lucie Popova, MD^_*,2, Subramanya Prasad, MD^_*, David O. Martin, MD^_*, Lourdes Prieto, MD^_*, Walid Saliba, MD^_*, Patrick Tchou, MD^_*, Mauricio Arruda, MD^_* and Andrea Natale, MD^_*,_*

^_* Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio
Department of Cardiovascular Science, University of Insubria, Varese, Italy.

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Variation of symptoms with lung perfusion. Scatter diagram showing the relation between the symptoms and the degree of perfusion of the affected lung indicating a negative correlation. As shown in the figure, all patients with grade 3 symptoms had a relative perfusion <25%.

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Correlation between lung perfusion and cumulative stenosis index (CSI). Scatter diagram showing the negative correlation between the relative lung perfusion and the CSI. Patients are labeled by their symptom grade. All patients having severe symptoms (grade 3) had a CSI 75% and a relative perfusion of <25% (located in the lower right quadrant), whereas asymptomatic patients or those having mild symptoms (grade 0 and 1, respectively) had a CSI <75% and a relative perfusion >25% (located in the upper left quadrant). S. grade = symptom grade (0 = asymptomatic; 1 = mild symptoms; 2 = moderate; 3 = severe).

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Correlation between timing of intervention and perfusion improvement. The scatter diagram shows the relation between the time from pulmonary vein occlusion diagnosis to the time of intervention and the improvement of the affected lung perfusion. Cases are labeled according to the degree of improvement of the cumulative stenosis index as detected by computed tomography scan. As shown, despite adequate restoration of vascular patency, later interventions were not associated with a significant improvement of perfusion. CT imp. = improvement of cumulative stenosis index by computed tomography.