Assessment and Management of Pulmonary Vein Occlusion After Atrial Fibrillation Ablation

Fender, Erin A.; Widmer, R. Jay; Hodge, David O.; Packer, Douglas L.; Holmes, David R.

doi:10.1016/j.jcin.2018.05.020

Cited by 31 publications

(31 citation statements)

References 19 publications

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“…This study describes mid‐ to long‐term outcomes of percutaneous intervention for the largest number of patients with PVS after PVI reported to date. It has been previously shown that for veins displaying close to normal or normal upstream diameter, stent implantation is superior to balloon dilation, with significantly higher re‐intervention rates for the latter . This is also clearly shown in this study and continues to hold true with longer term follow‐up.…”

Section: Discussionsupporting

confidence: 82%

“…4 Percutaneous intervention for PVS after PVI has been reported by several groups, all with relatively small numbers of patients and short to mid-term follow-up. [12][13][14][16][17][18] This study describes mid-to long-term outcomes of percutaneous intervention for the largest number of patients with PVS after PVI reported to date. It has been previously shown that for veins displaying close to normal or normal upstream diameter, stent implantation is superior to balloon dilation, with significantly higher re-intervention rates for the latter.…”

Section: Discussionmentioning

confidence: 99%

“…4 Percutaneous intervention is the current treatment approach for this syndrome, with previous reports documenting good acute and mid-term outcomes, although highly dependent on pre-intervention pulmonary vein anatomy. [12][13][14][16][17][18] This report will describe longer term outcomes of percutaneous pulmonary vein intervention from a single institution over a 16-year period.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Iatrogenic pulmonary venous obstruction (PVO) is a rare condition, most commonly reported as a complication following ablation for atrial fibrillation or after complex congenital cardiac surgery. [1][2][3][4][5] Patients with PVO commonly complain of dyspnea and hemoptysis. 1,6 In cases of PVO including multiple pulmonary veins, symptoms can be life threatening and require prompt intervention.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Patients with PVO commonly complain of dyspnea and hemoptysis. 1,6 In cases of PVO including multiple pulmonary veins, symptoms can be life threatening and require prompt intervention. 7 Percutaneous revascularization strategies are most commonly applied in the treatment of PVO.…”

Section: Introductionmentioning

confidence: 99%

Repair of iatrogenic pulmonary vein occlusion with a vascularized atrial flap

Chemtob

Smith

Hatipoğlu

et al. 2019

Clinical Case Reports

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractPulmonary vein obstruction is a rare condition, most commonly reported following pulmonary vein catheter ablation for atrial arrhythmia. This novel technique for treatment of pulmonary venous obstruction has the advantage of utilizing an autologous vascularized flap with intact endothelium for reconstruction of the pulmonary vein and to prevent restenosis. K E Y W O R D S atrial fibroelastoma, autologous, pulmonary vein reconstruction, pulmonary venous occlusion How to cite this article: Chemtob RA, Smith M, Hatipoglu U, et al. Repair of iatrogenic pulmonary vein occlusion with a vascularized atrial flap. Clin Case Rep.

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Recurrent pulmonary vein stenosis after successful intervention: Prognosis and management of restenosis

Fender

Widmer

Mahowald

et al. 2019

Cathet Cardio Intervent

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Objectives: The aim of this study was to describe management of recurrent pulmonary vein stenosis (PVS) and determine if stenting is superior to balloon angioplasty (BA) in preventing subsequent restenosis.Background: PVS is a serious complication of atrial fibrillation ablation. BA and stenting are effective therapies; however, restenosis frequently occurs. Here we report management of recurrent stenosis. Methods:This was a prospective observational study performed from 2000 to 2014.Results: One hundred and thirteen patients with severe PVS underwent intervention in 88 veins treated with BA and 81 treated with stenting. Forty-two patients experienced restenosis. Restenosis was more common in veins treated with BA (RRR 53%[95% CI 32-70%, p = .008]). A second intervention was performed in 41 patients. In the 34 vessels treated with initial BA, 24 were treated for restenosis with a stent and 10 were treated with a second BA. The recurrence rate was 46% in those treated with BA followed by stenting and 50% in those treated with two BA procedures. In the 22 veins treated with initial stenting, 9 were treated with another stent and 13 were treated with BA. The recurrence rate was 44% in those treated with a second stent and 46% for those treated with a stent followed by BA. The risk of a third stenosis was the same among all groups (Analysis of variance [ANOVA] p = .99). Limited sample size precluded analysis of outcome by stent size. Conclusions: Restenosis occurred in 44% of patients overall. Management is challenging; stenting does not appear to be superior to BA. K E Y W O R D S pulmonary vein stenosis, vascular patency, stents, balloon angioplasty, catheter ablation 1 | INTRODUCTION Pulmonary vein stenosis (PVS) is estimated to complicate between 0.3 and 3.4% of atrial fibrillation (AF) ablation procedures. 1-4 Severe PVS is frequently symptomatic; over 80% of patients experienced symptoms of shortness of breath, cough, chest pain, hemoptysis, and pulmonary infarction. 5 High grade stenosis can be effectively managed Abbreviations: AF, atrial fibrillation; ANOVA, analysis of variation; BA, balloon angioplasty; BMI, body mass index; BMS, bare metal stent; CHA 2 DS 2 VASc, congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke or TIA or thromboembolism, vascular disease, age 65-75, sex (female); CI, confidence interval; CT, computed tomography; DCB, drugcoated balloon; DES, drug-eluting stent; HR, hazard ratio; ICE, intracardiac echo; IQR, interquartile range; PV, pulmonary vein; PVS, pulmonary vein stenosis; RR, relative risk; SD, standard deviation; TIA, transient ischemic attack. This work was conducted at the Mayo Clinic, Rochester, MN. ;95:954-958. wileyonlinelibrary.com/journal/ccd All variables were analyzed using software from SAS (version 9.4, Cary, NC). Statistical analysis was carried out on both a per patient and a per vein level. Normally distributed continuous variables are reported as a mean and SD, whereas nonuniformly distributed continuous variables are reported using the median ...

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Assessment and Management of Pulmonary Vein Occlusion After Atrial Fibrillation Ablation

Cited by 31 publications

References 19 publications

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

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

Repair of iatrogenic pulmonary vein occlusion with a vascularized atrial flap

Recurrent pulmonary vein stenosis after successful intervention: Prognosis and management of restenosis

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