TY - JOUR
T1 - Pulmonary vein stenosis or occlusion after catheter ablation of atrial fibrillation
T2 - long-term comparison of drug-eluting versus large bare metal stents
AU - Fink, Thomas
AU - Schlüter, Michael
AU - Heeger, Christian Hendrik
AU - Lemes, Christine
AU - Lin, Tina
AU - Maurer, Tilman
AU - Metzner, Andreas
AU - Mathew, Shibu
AU - Reissmann, Bruno
AU - Wohlmuth, Peter
AU - Rillig, Andreas
AU - Ouyang, Feifan
AU - Kuck, Karl Heinz
AU - Tilz, Roland Richard
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Aims: Pulmonary vein stenosis or occlusion (PVS/O) following catheter ablation of atrial fibrillation is a rare but potentially severe complication. Treatment options include angioplasty with or without stent implantation, but data on outcome and optimal treatment strategy are limited. We report long-term results after catheter-based treatment of patients with symptomatic PVS/O. Methods and results: Retrospective analysis was performed in patients undergoing pulmonary vein (PV) angiography for suspected PVS/O. All patients with PVS/O were treated with balloon angioplasty and implantation of a coronary drug-eluting stent (DES) or a peripheral large-diameter bare metal stent (LD-BMS). A total of 25 high-degree PVS/Os in 19 patients were treated. Nine PVs were treated with angioplasty and DES implantation and 16 with angioplasty and LD-BMS implantation. The ostial PV diameter was not different in the DES and LD-BMS groups (10.2 ± 2.5 mm vs. 11.1 ± 1.9 mm, P = 0.34), but the PV/stent diameter ratio was significantly lower in the former (0.43 ± 0.13 vs. 0.82 ± 0.13, P < 0.0001). Angiographic stent restenosis was observed at a median of 539 (interquartile range 99-774) days in 9 of 23 (39%) treated PVs. The restenosis rate in the LD-BMS group was only one-third of that in the DES group [3/14 (21%) vs. 6/9 (67%), respectively; P = 0.08]. Conclusion: The use of LD-BMS for the treatment of PVS/O was associated with an acceptable long-term outcome. Coronary DES implantation resulted in a high rate of restenosis and should therefore not be performed. Larger trials are needed to confirm our findings.
AB - Aims: Pulmonary vein stenosis or occlusion (PVS/O) following catheter ablation of atrial fibrillation is a rare but potentially severe complication. Treatment options include angioplasty with or without stent implantation, but data on outcome and optimal treatment strategy are limited. We report long-term results after catheter-based treatment of patients with symptomatic PVS/O. Methods and results: Retrospective analysis was performed in patients undergoing pulmonary vein (PV) angiography for suspected PVS/O. All patients with PVS/O were treated with balloon angioplasty and implantation of a coronary drug-eluting stent (DES) or a peripheral large-diameter bare metal stent (LD-BMS). A total of 25 high-degree PVS/Os in 19 patients were treated. Nine PVs were treated with angioplasty and DES implantation and 16 with angioplasty and LD-BMS implantation. The ostial PV diameter was not different in the DES and LD-BMS groups (10.2 ± 2.5 mm vs. 11.1 ± 1.9 mm, P = 0.34), but the PV/stent diameter ratio was significantly lower in the former (0.43 ± 0.13 vs. 0.82 ± 0.13, P < 0.0001). Angiographic stent restenosis was observed at a median of 539 (interquartile range 99-774) days in 9 of 23 (39%) treated PVs. The restenosis rate in the LD-BMS group was only one-third of that in the DES group [3/14 (21%) vs. 6/9 (67%), respectively; P = 0.08]. Conclusion: The use of LD-BMS for the treatment of PVS/O was associated with an acceptable long-term outcome. Coronary DES implantation resulted in a high rate of restenosis and should therefore not be performed. Larger trials are needed to confirm our findings.
UR - http://www.scopus.com/inward/record.url?scp=85054891937&partnerID=8YFLogxK
U2 - 10.1093/europace/eux291
DO - 10.1093/europace/eux291
M3 - Journal articles
C2 - 29069364
AN - SCOPUS:85054891937
SN - 1099-5129
VL - 20
SP - e148-e155
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 10
ER -
