Antithrombotic therapy after angioplasty of pulmonary vein stenosis due to atrial fibrillation ablation: A two-center experience and review of the literature

Thomas Fink*, Julia Vogler, Riccardo Proietti, Vanessa Sciacca, Christian Hendrik Heeger, Laura Rottner, Tilman Maurer, Andreas Metzner, Shibu Mathew, Charlotte Eitel, Ingo Eitel, Christian Sohns, Makoto Sano, Bruno Reissmann, Andreas Rillig, Feifan Ouyang, Karl Heinz Kuck, Roland Richard Tilz

*Korrespondierende/r Autor/-in für diese Arbeit
1 Zitat (Scopus)

Abstract

Background: Pulmonary vein stenosis (PVS) is a severe complication of atrial fibrillation (AF) ablation resulting in narrowing of affected pulmonary veins (PVs). Interventional treatment consists of angioplasty with or without PV stenting. The optimal postprocedural antithrombotic therapy is not known. Study aims: To investigate the impact of antithrombotic medical therapy on recurrence of PVS after PV angioplasty. Methods: A retrospective study of patients undergoing PV angioplasty with or without stent implantation in two German centers was performed. Postinterventional antithrombotic therapy consisted of either dual antiplatelet therapy (DAPT) or a combination of oral anticoagulation with single or dual antiplatelet therapy for 3–12 months after intervention. Angiographic follow-up was recommended 3, 6, and 12 months after intervention and in case of symptom recurrence. Results: Thirty patients underwent treatment of 42 PVS. After intervention, twenty-eight patients received triple therapy and 14 patients received dual therapy/DAPT; restenosis occurred in 5/22 (22.7%) patients with triple therapy and 8/14 (57.1%) patients with dual therapy/DAPT PV (p =.001). Estimated freedom from PV restenosis after 500 days was 18.8 ± 15.8% (dual therapy/DAPT) and 76.2 ± 10.5% (triple therapy) (p =.003). Univariate regression analysis revealed postprocedural medication as a significant risk factor for restenosis (p =.019). No bleeding events occurred regardless of applied antithrombotic therapy. Conclusion: Triple antithrombotic therapy after PV angioplasty is associated with less frequent restenosis as compared to dual antiplatelet therapy or a combination of anticoagulation and single antiplatelet therapy. No severe bleeding events occurred in patients on triple therapy. These findings need to be confirmed in larger patient cohorts.

OriginalspracheEnglisch
ZeitschriftJournal of Arrhythmia
Jahrgang38
Ausgabenummer6
Seiten (von - bis)1009-1016
Seitenumfang8
ISSN1880-4276
DOIs
PublikationsstatusVeröffentlicht - 12.2022

Strategische Forschungsbereiche und Zentren

  • Zentren: Universitäres Herzzentrum Lübeck (UHZL)

DFG-Fachsystematik

  • 205-12 Kardiologie, Angiologie

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