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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2008

Open Access 01-12-2008 | Research article

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

Authors: Pierre-André Doriot, Pierre-André Dorsaz, Dipen Chandrakant Shah

Published in: Journal of Cardiothoracic Surgery | Issue 1/2008

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Abstract

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.
Appendix
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Metadata
Title
Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up ? A potential explanation
Authors
Pierre-André Doriot
Pierre-André Dorsaz
Dipen Chandrakant Shah
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2008
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-3-24

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