Katharina Schoene1, Arash Arya2, Cosima Jahnke2, Ingo Paetsch2, Sotirios Nedios2, Sebastian Hilbert2, Andreas Bollmann2, Gerhard Hindricks3, Philipp Sommer2. 1. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany. Electronic address: katharina.schoene@helios-gesundheit.de. 2. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. 3. Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany.
Abstract
OBJECTIVES: The aim of the present study was to analyze and report a single-center experience with catheter interventional treatment of radiofrequency-induced pulmonary vein stenosis (PVS) following atrial fibrillation (AF) ablation. BACKGROUND: Catheter interventional treatment of radiofrequency-induced PVS following AF ablation remains a challenging field because of a lack of randomized data and treatment guidelines. METHODS: All patients at a single center who underwent catheter interventional treatment for radiofrequency-induced PVS were retrospectively assessed. RESULTS: From January 2004 to September 2017, the total rate of PVS following interventional AF ablation was 0.78% (87 of 11,103). Thirty-nine patients with PVS were treated with 84 catheter interventions: 68 (81%) with percutaneous transluminal balloon angioplasty (PTA) and 16 (19%) with stent implantation. The distribution of stent type was 3 drug-eluting stents (19%) and 13 bare-metal stents (81%). The overall restenosis rate was 53% after PTA versus 19% after stent implantation (p = 0.007) after a median follow-up period of 6 months (interquartile range: 3 to 55 months). The total complication rate for PTA was 10% versus 13% for stenting (p = NS). CONCLUSIONS: This study demonstrates significantly better outcomes in terms of restenosis after stent implantation versus PTA only, with comparable complication rates for these 2 options of interventional treatment of radiofrequency-induced PVS. In summary, despite the lack of randomized studies, the present data and currently available published studies seem to favor stent implantation as a first-line therapy in patients with radiofrequency-induced severe PVS.
OBJECTIVES: The aim of the present study was to analyze and report a single-center experience with catheter interventional treatment of radiofrequency-induced pulmonary vein stenosis (PVS) following atrial fibrillation (AF) ablation. BACKGROUND: Catheter interventional treatment of radiofrequency-induced PVS following AF ablation remains a challenging field because of a lack of randomized data and treatment guidelines. METHODS: All patients at a single center who underwent catheter interventional treatment for radiofrequency-induced PVS were retrospectively assessed. RESULTS: From January 2004 to September 2017, the total rate of PVS following interventional AF ablation was 0.78% (87 of 11,103). Thirty-nine patients with PVS were treated with 84 catheter interventions: 68 (81%) with percutaneous transluminal balloon angioplasty (PTA) and 16 (19%) with stent implantation. The distribution of stent type was 3 drug-eluting stents (19%) and 13 bare-metal stents (81%). The overall restenosis rate was 53% after PTA versus 19% after stent implantation (p = 0.007) after a median follow-up period of 6 months (interquartile range: 3 to 55 months). The total complication rate for PTA was 10% versus 13% for stenting (p = NS). CONCLUSIONS: This study demonstrates significantly better outcomes in terms of restenosis after stent implantation versus PTA only, with comparable complication rates for these 2 options of interventional treatment of radiofrequency-induced PVS. In summary, despite the lack of randomized studies, the present data and currently available published studies seem to favor stent implantation as a first-line therapy in patients with radiofrequency-induced severe PVS.