A Cased-based Review of the Role of Lung Perfusion Scintigraphy in the Evaluation of Pulmonary Vein Stenosis after Radiofrequency Ablation

Objectives: Symptomatic pulmonary vein stenosis after the treatment of patients with atrial fibrillation with radiofrequency ablation (RF) is a known complication that occurs in up to 2% of patients. Although the degree of anatomic stenosis is best evaluated by ECG-gated CTA, scintigraphic imaging plays a critical role in determining the hemodynamic significance of stenosis. The goal of this educational exhibit is to give an illustrative, case-based review of the nuclear medicine pulmonary perfusion imaging in the evaluation of pulmonary vein stenosis.

Methods: Cases evaluated at the University of Pennsylvania Health System will be included in this educational exhibit. Our experiences with clinical patient selection and study interpretation will be discussed.

Results: The exhibit will include a presentation of the following: ● discussion of pulmonary vein isolation using RF ablation ● appropriate clinical indications for scintigraphic perfusion imaging in the work-up of pulmonary vein stenosis ● discussion of interventions to treat pulmonary vein stenosis including the problem of restenosis after treatment ● representative imaging findings for a variety of patient presentations including evaluation of initial stenosis and restenosis after percutaneous intervention Summary/Conclusions:The development of pulmonary vein stenosis is an uncommon but serious complication after pulmonary vein isolation using RF ablation. Scintigraphic imaging plays a helpful role in determining the hemodynamic significance of stenoses. The development of a quantitative perfusion-only scintigraphic protocol should be considered for optimal evaluation in these patients. Furthermore, although no definite guidelines have been developed, consideration should be given to the development of a screening protocol for pulmonary venous stenosis after RF ablation, particularly in patients after intervention given the relatively high rate of restenosis. References 1. Barrett CD et al . How to Identify and Treat Patient with Pulmonary Vein Stenosis post Atrial Fibrillation Ablation. Curr Opin Cardiol. 2009;24:42. 2. Nanthakumar K et al . Functional Assessment of Pulmonary Vein Stenosis using Radionuclide Ventilation/Perfusion Imaging. Chest. 2004;126:645. 3. Preito LR. The State of the Art in Pulmonary Vein Stenosis - Diagnosis & Treatment. J Atr Fibrillation. 2010;2:228.