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Pulmonary vein stenosis after HotBalloon pulmonary vein isolation of paroxysmal atrial fibrillation

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Abstract

HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary vein (PV) stenosis remains a concern. The influence of longer application duration on PV stenosis has not yet been systematically evaluated. All patients who underwent first HBPVI of PAF with pre- and post-ablation computed tomography (CT) were included. We used single-shot technique with application duration of 180 s in the RSPV, 180–240 s in the LSPV, and 120 s in the lower PV procedures. PV stenosis was analyzed using CT and categorized as moderate (50–70%), and severe (> 70%) reduction in PV diameter. We analyzed imaging of the PV anatomy before ablation and during follow-up in 84 patients. Among them, 7 (8.3%) showed moderate stenosis, and 3 (3.6%) had severe stenosis including one total occlusion patient. All severe stenosis and total occlusion occurred in RSPV and LSPV procedures with longer application duration. No severe stenosis nor total PV occlusion occurred in inferior PV procedures with shorter application duration. The incidence of PV stenosis ≥ 50% or total PV occlusion was significantly lower in inferior PV than RSPV and LSPV procedures (0.6%, 6.0%, 8.0%, p = 0.01, respectively). All cases of PV stenosis including total PV occlusion patients were asymptomatic. No intervention for PV stenosis was performed. The risk of PV stenosis in HBPVI was rare in lower PV procedure with shorter application duration. An application duration setting of 120 s in lower PV procedure might be effective to prevent PV stenosis.

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Acknowledgements

We would like to thank Mr. T. Morioka for his technical support for analyzing the CT images, and Mr. K. Ishiyama and Ms. I. Tanikawa for collecting data of procedures.

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Authors and Affiliations

  1. The Heart Rhythm Center, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan

    Yoshinori Nakamura, Hiroshi Sohara & Minoru Ihara

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  1. Yoshinori Nakamura
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  2. Hiroshi Sohara
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  3. Minoru Ihara
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Correspondence to Yoshinori Nakamura.

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Yoshinori Nakamura none, Minoru Ihara none, Hiroshi Sohara, Toray Industries. Consulting fees from Toray Industries.

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Nakamura, Y., Sohara, H. & Ihara, M. Pulmonary vein stenosis after HotBalloon pulmonary vein isolation of paroxysmal atrial fibrillation. Heart Vessels 36, 1739–1745 (2021). https://doi.org/10.1007/s00380-021-01862-7

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  • DOI: https://doi.org/10.1007/s00380-021-01862-7

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