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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Radiofrequency Treatment of Abnormal Heart Rhythm Can Damage the Vessels That Return Blood from the Lungs to the Heart
15 April 2003 | Volume 138 Issue 8 | Page I-41
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation: Emergence of a New Clinical Syndrome." It is in the 15 April 2003 issue of Annals of Internal Medicine (volume 138, pages 634-638). The authors are E.B. Saad, N.F. Marrouche, C.P. Saad, E. Ha, D. Bash, R.D. White, J. Rhodes, L. Prieto, D.O. Martin, W.I. Saliba, R.A. Schweikert, and A. Natale.
What is the problem and what is known about it so far?
The regular rhythm of the heart depends on electrical impulses that stimulate the heart muscle to contract (beat). Sometimes, abnormal electrical impulses produce irregular rhythms (arrhythmias). One of the most common types of arrhythmia is called atrial fibrillation, in which abnormal electrical impulses are produced in the walls of the blood vessels that return blood from the lungs to the heart (pulmonary veins). Doctors can prevent these abnormal electrical impulses from reaching the heart by destroying the electrical pathway that runs from the pulmonary veins into the heart. A new and highly effective method of doing this is with radio waves delivered by using a thin plastic tube (catheter) that is inserted into the pulmonary veins. This treatment is known as radiofrequency catheter ablation (destruction). Although it frequently cures the arrhythmia, it can also damage the pulmonary veins, causing scar tissue that narrows the veins and blocks the flow of blood returning to the heart.
Why did the researchers do this particular study?
To find out how often radiofrequency catheter ablation caused scar tissue to block the pulmonary veins, whether symptoms could help diagnose the problem, and whether treatment was effective.
Who was studied?
335 patients with atrial fibrillation who underwent radiofrequency catheter ablation.
How was the study done?
The researchers reviewed the patients' medical records. All patients had computed tomography performed 3 months after treatment to detect narrowing of the pulmonary veins. Doctors examined the patients 3, 6, and 12 months after treatment.
What did the researchers find?
Eighteen patients developed severe vein narrowing. Some patients with narrowing noticed symptoms that included shortness of breath, cough, chest pain, or coughing up blood. Half of the affected patients had an abnormal chest x-ray, but the abnormalities were frequently misdiagnosed as pneumonia, lung cancer, or blood clots in the lung and incorrect treatment was often given. Correct treatment, which consisted of opening the narrowed veins, led to immediate improvement in most of the patients.
What are the limitations of the study?
Since the information came from previous medical records rather than evaluation as events took place, some patients with this complication may have been missed. Also, the number of people studied was relatively small and the true rate of occurrence of this complication may be different from the rate reported by the authors.
What are the implications of the study?
Narrowing of pulmonary veins after radiofrequency catheter ablation of atrial fibrillation is not uncommon but is frequently misdiagnosed. Therefore, doctors must routinely search for this complication and treat it promptly.
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