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Long-term follow-up in patients treated by stent implantation for post-ablation pulmonary vein stenosis

Abstract

Purpose

Symptomatic severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a rare but well-recognized complication. Treatment options include pulmonary vein angioplasty with or without drug eluting balloons or angioplasty with stent implantation. The treatment of choice is unclear. In our center, pulmonary vein stenting is the treatment of choice for significantly stenotic veins. We present the long-term clinical outcome of 9 patients treated with stent implantation.

Methods

Between 2001 and 2015, 3048 patients with AF were treated with catheter ablation at our institution, of which 9 developed symptomatic PVS. A total of 11 PVS were treated. Pre-procedural imaging (CT, MR, transesophageal echocardiography, angiography) was performed in all patients.

Results

Mean time from ablation to stenting was 18 months. Three patients had recurrent pneumonia and the remaining reduced functional capacity (NYHA 2). All patients were in functional capacity NYHA 1 (p < 0.05) after a mean follow-up of 64 (18–132) months. Three patients still had paroxysmal AF, of which two have undergone repeated ablation.

Conclusions

Symptomatic PVS after AF ablation can be successfully treated by stent implantation with durable results and good clinical outcome. AF ablation is still a feasible option after stent deployment.

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Fig. 1

Abbreviations

AF:

Atrial fibrillation

RFA:

Radiofrequency catheter ablation

PV:

Pulmonary vein

PVS:

Pulmonary vein stenosis

NYHA:

New York Heart Association Functional Classification

TEE:

Transesophageal echocardiography

TSP:

Transseptal puncture

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Correspondence to Elisabeth Iversen.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and the national research committee.

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Informed consent was obtained from all individual participants included in the study.

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Iversen, E., Packer, E.J.S., Sandberg, S.M. et al. Long-term follow-up in patients treated by stent implantation for post-ablation pulmonary vein stenosis. J Interv Card Electrophysiol 53, 309–315 (2018). https://doi.org/10.1007/s10840-018-0370-y

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  • DOI: https://doi.org/10.1007/s10840-018-0370-y

Keywords

  • Atrial fibrillation
  • Ablation
  • Pulmonary vein stenosis
  • Stent implantation
  • Long-term follow-up