Arun Kanmanthareddy1, Ajay Vallakati2, Madhu Reddy Yeruva3, Sanjay Dixit4, Luigi DI Biase5, Moussa Mansour6, Hemant Boolani7, Sampath Gunda3, T Jared Bunch3, John D Day8, Jeremy N Ruskin6, Avanija Buddam3, Sandeep Koripalli3, Sudharani Bommana3, Andrea Natale9, Dhanunjaya Lakkireddy3. 1. Division of Cardiology, Creighton University, Omaha, Nebraska, USA. 2. Division of Cardiology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA. 3. KU Cardiovascular Research Institute, The University of Kansas Hospital and Medical Center, Kansas City, Kansas, USA. 4. Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Division of Cardiology, Albert Einstein Montefiore Medical Center, Bronx, New York, USA. 6. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA. 7. Division of Cardiology, Howard University Hospital, Washington, District of Columbia, USA. 8. Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA. 9. Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Abstract
BACKGROUND: Pulmonary vein isolation (PVI) of the remnant pulmonary vein (PV) stumps in pneumonectomy patients has not been well characterized. METHODS: This is a multicenter observational study of patients with a remnant PV stump after pneumonectomy. Consecutive patients with a history of pneumonectomy and who had undergone RF ablation for drug refractory AF were identified from the AF database at the participating institutions. RESULTS: There were 15 patients in whom pneumonectomy was performed, for resection of tumors in 10, infection in 4, and bullae in 1 patient and who underwent RF ablation for AF. The mean age was 63 ± 7 years. The stumps were from the right lower PV in 5, left upper PV in 5, left lower PV in 3, and right upper PV in 2 patients. All the PV stumps were electrically active with PV potentials and 9 (60%) of them had triggered activity. PVI was performed in 14 and focal isolation in 1 patient. At 1-year follow-up, 80% were free of AF, off of antiarrhythmic medications. CONCLUSION: PV stumps in AF patients with previous pneumonectomy are electrically active and are frequently the sites of active firing. Isolation of these PV stumps can be accomplished safely and effectively using catheter ablation with no practical concern for PV stenosis or compromising PV stump integrity.
BACKGROUND: Pulmonary vein isolation (PVI) of the remnant pulmonary vein (PV) stumps in pneumonectomy patients has not been well characterized. METHODS: This is a multicenter observational study of patients with a remnant PV stump after pneumonectomy. Consecutive patients with a history of pneumonectomy and who had undergone RF ablation for drug refractory AF were identified from the AF database at the participating institutions. RESULTS: There were 15 patients in whom pneumonectomy was performed, for resection of tumors in 10, infection in 4, and bullae in 1 patient and who underwent RF ablation for AF. The mean age was 63 ± 7 years. The stumps were from the right lower PV in 5, left upper PV in 5, left lower PV in 3, and right upper PV in 2 patients. All the PV stumps were electrically active with PV potentials and 9 (60%) of them had triggered activity. PVI was performed in 14 and focal isolation in 1 patient. At 1-year follow-up, 80% were free of AF, off of antiarrhythmic medications. CONCLUSION: PV stumps in AFpatients with previous pneumonectomy are electrically active and are frequently the sites of active firing. Isolation of these PV stumps can be accomplished safely and effectively using catheter ablation with no practical concern for PV stenosis or compromising PV stump integrity.
Authors: Andrea Demarchi; Giulio Conte; Shih-Ann Chen; Li-Wei Lo; Wei-Tso Chen; Tom De Potter; Peter Geelen; Andrea Sarkozy; Francesco R Spera; Tobias Reichlin; Laurent Roten; Pascal Defaye; Adrien Carabelli; Serge Boveda; Hamed Bourenane; Lisa Riesinger; Simon Kochhäuser; Gala Caixal; Lluis Mont; Daniel Scherr; Martin Manninger; Francesco Pentimalli; Stefano Cornara; Catherine Klersy; Angelo Auricchio Journal: J Clin Med Date: 2022-03-08 Impact factor: 4.241