Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation

Schoene, Katharina; Arya, Arash; Jahnke, Cosima; Paetsch, Ingo; Nedios, Sotirios; Hilbert, Sebastian; Bollmann, Andreas; Hindricks, Gerhard; Sommer, Philipp

doi:10.1016/j.jcin.2018.05.016

Cited by 40 publications

(66 citation statements)

References 20 publications

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“…Replacing focal PV ablation with circumferential antral ablation technique as well as the use of three‐dimensional mapping systems has lowered the mean incidence of PVS from 6.3% (estimated from publications between 1999 and 2004) to currently less than 1% . As recently published, the total PVS rate for ablation of AF in our cohort was 0.78% (87 of 11 103) . We also reported our experience in catheter intervention as well as surgical treatment of PVS with the lowest rate of restenosis after stent implantation …”

Section: Introductionsupporting

confidence: 75%

“…Backflow resistance following PV occlusion increases the pulmonary capillary pressure, which can cause pulmonary hypertension. Nevertheless, it remains unclear why pulmonary hypertension occurs only in one‐third of patients with severe PVS . Pre‐existing left ventricular dysfunction, valvular and/or coronary heart disease are proposed as potential mechanisms leading to elevated right ventricular pressure following AF ablation …”

Section: Discussionmentioning

confidence: 99%

“…Our screening protocol has been recently published . In brief, from 2004 to 2007, transesophageal echocardiography was performed as routine screening between 6 and 12 months after PVI.…”

Section: Methodsmentioning

confidence: 99%

“…As recently published, the total PVS rate for ablation of AF in our cohort was 0.78% (87 of 11 103) . We also reported our experience in catheter intervention as well as surgical treatment of PVS with the lowest rate of restenosis after stent implantation …”

Section: Introductionmentioning

confidence: 99%

“…Follow‐up imaging seems to be even more sporadically performed. We must keep in mind that severe PVS can also be asymptomatic . A few studies investigated the short‐ and medium‐term follow‐up of PVS .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Natural course of acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation—Is routine follow‐up imaging indicated or not?

Schoene

Shamloo

Sommer

et al. 2019

Cardiovasc electrophysiol

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Introduction Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). The aim of the present study was to analyze the natural course of RFA‐induced PVS with regard to the grade of stenosis, clinical symptoms, and mortality during long‐term follow‐up. Methods and Results All patients with follow‐up imaging for radiofrequency‐induced untreated PVS were retrospectively assessed. From 2004 to 2017, the total rate of PVS following AF ablation in our center was 0.78% (87 of 11 103). Thirty‐eight patients with a total of 54 untreated PVS underwent follow‐up including imaging scan. The mean degree of stenosis at the time of diagnosis was 57% ± 27% vs 45% ± 35% (P = .05) after a mean follow‐up of 43 ± 31 months. There was a shift in severity of the PVS: 18 of 54 (33%) vs 16 of 54 (30%) severe PVS, 19 of 54 (35%) vs 10 of 54 (18%) moderate PVS, and 17 of 54 (32%) vs 28 of 54 (52%) mild PVS (P = .0001). The mean symptom score decreased significantly during follow‐up (1.8 ± 1.0 vs 0.4 ± 0.5, P = .0001). Each of the four patients with progression of PVS underwent another pulmonary vein isolation for AF recurrence following pulmonary vein reconduction during follow‐up period. Conclusion This study showed a spontaneous reduction in stenosis grade and symptoms of PVS over a 3.5‐year follow‐up. Consequently, routine follow‐up imaging of PVS seems not to be necessary. However, additional RF energy delivery to stenotic pulmonary veins should be avoided if possible. In case of conduction recovery, the ablation line should be done wide‐antrally and follow‐up imaging of PVS is recommended.

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Section: Introductionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

“…Our screening protocol has been recently published . In brief, from 2004 to 2007, transesophageal echocardiography was performed as routine screening between 6 and 12 months after PVI.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Natural course of acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation—Is routine follow‐up imaging indicated or not?

Schoene

Shamloo

Sommer

et al. 2019

Cardiovasc electrophysiol

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Targeted Rapamycin Delivery via Magnetic Nanoparticles to Address Stenosis in a 3D Bioprinted in Vitro Model of Pulmonary Veins

Ning,

Zanella,

Tomov

et al. 2024

Advanced Science

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Vascular cell overgrowth and lumen size reduction in pulmonary vein stenosis (PVS) can result in elevated PV pressure, pulmonary hypertension, cardiac failure, and death. Administration of chemotherapies such as rapamycin have shown promise by inhibiting the vascular cell proliferation; yet clinical success is limited due to complications such as restenosis and off‐target effects. The lack of in vitro models to recapitulate the complex pathophysiology of PVS has hindered the identification of disease mechanisms and therapies. This study integrated 3D bioprinting, functional nanoparticles, and perfusion bioreactors to develop a novel in vitro model of PVS. Bioprinted bifurcated PV constructs are seeded with endothelial cells (ECs) and perfused, demonstrating the formation of a uniform and viable endothelium. Computational modeling identified the bifurcation point at high risk of EC overgrowth. Application of an external magnetic field enabled targeting of the rapamycin‐loaded superparamagnetic iron oxide nanoparticles at the bifurcation site, leading to a significant reduction in EC proliferation with no adverse side effects. These results establish a 3D bioprinted in vitro model to study PV homeostasis and diseases, offering the potential for increased throughput, tunability, and patient specificity, to test new or more effective therapies for PVS and other vascular diseases.

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Long‐term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure

Suntharos

Worley

Liu

et al. 2019

Cathet Cardio Intervent

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Objectives Report long‐term outcomes of percutaneous intervention in patients with pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) from a single center over 16 years. Background Outcome reports of percutaneous intervention for PVS resulting from PVI are limited. Methods Retrospective review of all patients with PVS after PVI who underwent percutaneous intervention at the Cleveland Clinic Foundation between January 2000 and December 2016. Results A total of 205 patients underwent cardiac catheterization for PVS during the study period. Completely occluded veins which could not be recanalized occurred in six patients. Of the remaining 199 patients, 27 (14%) were lost to follow‐up, leaving 172 patients with 276 veins for analysis. Balloon angioplasty was performed in 62 veins and stent implantation in 250 (primary in 214, to treat postdilation restenosis in 36). Re‐intervention occurred in 45/62 (73%) balloon‐dilated veins and 45/250 (18%) stented veins. Freedom from re‐intervention at 1 and 5 years was 90 and 73% following stenting versus 40 and 23% following balloon dilation (p < .001, Hazard ratio (HR) = 5.7). Veins with stent diameter ≥7 mm (n = 231) had greater freedom from re‐intervention (95% at 1 year, 79% at 5 years) than veins with stents <7 mm (43% at 1 year, 9% at 5 years), p < .001. There was clear symptomatic improvement after intervention and no procedural mortality. Conclusions Stent implantation at ≥7 mm for PVS after PVI is associated with low rates of re‐intervention, in contrast to balloon dilation and stenting with small conventional stents.

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Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation

Cited by 40 publications

References 20 publications

Natural course of acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation—Is routine follow‐up imaging indicated or not?

Natural course of acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation—Is routine follow‐up imaging indicated or not?

Targeted Rapamycin Delivery via Magnetic Nanoparticles to Address Stenosis in a 3D Bioprinted in Vitro Model of Pulmonary Veins

Long‐term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure

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