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

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.

Pulmonary Vein Intervention for Severe Pulmonary Vein Stenosis After Atrial Fibrillation Ablation ― A Retrospective Cohort Study ―

“…However, it has been reported that the rate of restenosis in the chronic phase was lower in patients treated with triple therapy. 33 In the present cohort, only 1 patient received triple therapy. It is unclear whether these data are applicable to the Japanese population, which has a high incidence of bleeding events.…”

Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation Using a Cryoballoon, Hot Balloon, or Laser Balloon

“…We did not use the balloon devices for patients with a common PV trunk or right A lthough pulmonary vein isolation (PVI) has been established as a cornerstone treatment for atrial fibrillation (AF), 1 PV stenosis (PVS) after PVI remains a major complication requiring intervention and is associated with significant morbidity. [2][3][4][5] As the performance of wide encircling PVI using radiofrequency (RF) catheters spread around the world, the incidence of PVS has decreased. However, with the recent development of various balloon devices (e.g., cryoballoon [CB], hot balloon [HB], and laser balloon [LB]), PVS has increased again, because segmental PVI is required.…”