Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up? A potential explanation

Article Article scientifique Article Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up? A potential explanation eng 2008 author Doriot Pierre-André 516954 author Dorsaz Pierre-André 605456 author Shah Dipen 559124 24 10.1186/1749-8090-3-24 18457581 1749-8090 http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18457581 BACKGROUND: Radiofrequency catheter ablation of excitation foci inside pulmonary veins (PV) generates stenoses that can become quite severe during or after the follow-up period. Since severe PV stenoses have most often disastrous consequences, it would be important to know the underlying mechanism of this temporal evolution. The present study proposes a potential explanation based on mechanical considerations. METHODS: we have used a mathematical-physical model to examine the cyclic increase in axial wall stress induced in the proximal (= upstream), non-stenosed segment of a stenosed pulmonary vein during the forward flow phases. In a representative example, the value of this increase at peak flow was calculated for diameter stenoses (DS) ranging from 1 to 99%. RESULTS: The increase becomes appreciable at a DS of roughly 30% and rise then strongly with further increasing DS value. At high DS values (e.g. > 90%) the increase is approximately twice the value of the axial stress present in the PV during the zero-flow phase. CONCLUSION: Since abnormal wall stresses are known to induce damages and abnormal biological processes (e.g., endothelium tears, elastic membrane fragmentations, matrix secretion, myofibroblast generation, etc) in the vessel wall, it seems plausible that the supplementary axial stress experienced cyclically by the stenotic and the proximal segments of the PV is responsible for the often observed progressive reduction of the vessel lumen after healing of the ablation injury. In the light of this model, the only potentially effective therapy in these cases would be to reduce the DS as strongly as possible. This implies most probably stenting or surgery. Angiography Atrial Fibrillation/surgery Blood Flow Velocity Catheter Ablation/adverse effects Disease Progression Electrocardiography Follow-Up Studies Humans Models, Cardiovascular Postoperative Complications Pulmonary Veno-Occlusive Disease/diagnosis/etiology/physiopathology Pulmonary Wedge Pressure/physiology Dewey 616 56 Département de médecine 221 false 398 Electrophysiologie 666 Journal of cardiothoracic surgery 3 9be70227-4aea-42b1-9a29-5442dcad7a48 Article (Accepted version) Public Article.pdf 410738 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up? A potential explanation	Journal of cardiothoracic surgery			2008	681	467

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Doriot, Pierre-André