Katharina Schoene1,2, Arash Arya3, Cosima Jahnke3, Ingo Paetsch3, Nikolaos Dagres3, Andreas Bollmann3, Gerhard Hindricks3,4, Philipp Sommer3. 1. Department of Electrophysiology, Heart Center, University of Leipzig, Germany. schoene_katha@t-online.de. 2. Leipzig Heart Institute GmbH, Leipzig, Germany. schoene_katha@t-online.de. 3. Department of Electrophysiology, Heart Center, University of Leipzig, Germany. 4. Leipzig Heart Institute GmbH, Leipzig, Germany.
Abstract
BACKGROUND: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. METHODS: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). RESULTS: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found. CONCLUSIONS: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.
BACKGROUND: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. METHODS: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). RESULTS: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found. CONCLUSIONS: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.
Authors: Sascha Rolf; Simon Kircher; Arash Arya; Charlotte Eitel; Philipp Sommer; Sergio Richter; Thomas Gaspar; Andreas Bollmann; David Altmann; Carlos Piedra; Gerhard Hindricks; Christopher Piorkowski Journal: Circ Arrhythm Electrophysiol Date: 2014-08-23
Authors: Philipp Sommer; Sascha Rolf; Christopher Piorkowski; Thomas Gaspar; Yan Huo; Carlos Piedra; Sergio Richter; Andreas Bollmann; Arash Arya; Gerhard Hindricks Journal: Circ Arrhythm Electrophysiol Date: 2014-07-19
Authors: Malcolm C Finlay; Ross J Hunter; Victoria Baker; Laura Richmond; Farai Goromonzi; Glyn Thomas; Kim Rajappan; Edward Duncan; Muzahir Tayebjee; Mehul Dhinoja; Simon Sporton; Mark J Earley; Richard J Schilling Journal: J Interv Card Electrophysiol Date: 2011-11-26 Impact factor: 1.900