Incidence of Pulmonary Vein Stenosis After Radiofrequency Catheter Ablation of Atrial Fibrillation

Teunissen, Cas; Velthuis, Birgitta K.; Hassink, Rutger J.; Heijden, Jeroen F. van der; Vonken, Evert-Jan P.A.; Clappers, Nick; Doevendans, Pieter A.; Loh, Peter

doi:10.1016/j.jacep.2017.02.003

Cited by 60 publications

(49 citation statements)

References 29 publications

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“…In one report, the incidence rate of severe PV stenosis was less than 1% and the incidence rate of symptomatic PV stenosis necessitating intervention was negligible. 18 This is mainly due to the change in the ablation technique by adopting an antral ablation approach. 19 The wide diameter of the antrum prevents PV stenosis, even in the presence of scar retraction at the ablation sites.…”

Section: Prevention and Management Of Complications And Collateral Damentioning

confidence: 99%

Radiofrequency Catheter Ablation: How to Manage and Prevent Collateral Damage?

Baba

Sabayon

Refaat

2020

J Innov Cardiac Rhythm Manage.

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Radiofrequency catheter ablation has become the standard of care for the management of various arrhythmias and, in fact, the first-line therapy for many tachyarrhythmias. It entails creating scar tissue in the heart in regions where abnormal impulses form or propagate to restore normal cardiac conduction. As the heart is a complex organ and is surrounded by and related to many other anatomical structures, it is important to avoid the collateral damage that can happen from radiofrequency (RF) ablation on the endocardium as well as on the epicardium. This review explores methods for mitigating or limiting collateral damage during catheter ablation.

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Section: Prevention and Management Of Complications And Collateral Damentioning

confidence: 99%

Radiofrequency Catheter Ablation: How to Manage and Prevent Collateral Damage?

Baba

Sabayon

Refaat

2020

J Innov Cardiac Rhythm Manage.

View full text Add to dashboard Cite

show abstract

“…2 Previous studies showed that the left-sided PVs are most commonly affected. 9,13,14 This may be a consequence of anatomic conditions such as the small diameter of the left inferior PV and the cranial position of the left superior PV with the steep ridge leading to ablation sites closer to the PV ostium. 15 Pre-existing Symptomatic, n (%) 12 (32) 5 (13) .054…”

Section: Pathophysiology Of Pvs and Progression By Reablationmentioning

confidence: 99%

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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“…Existing literature shows that the incidence of this complication is up to 31.4% at present. 1 Previous studies have reported the efficacy of catheter intervention for the treatment of PVS, including balloon angioplasty and stenting. However, in some cases, restenosis of the veins can occur following catheter intervention.…”

Section: Introductionmentioning

confidence: 99%

A case of balloon angioplasty guided by integrated backscatter intravascular ultrasound for the treatment of pulmonary vein stenosis caused by radiofrequency atrial fibrillation

Tsukahara

Oginosawa

Sonoda

et al. 2019

HeartRhythm Case Reports

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Incidence of Pulmonary Vein Stenosis After Radiofrequency Catheter Ablation of Atrial Fibrillation

Abstract: Although mild PVS was frequently observed after RFCA in this large cohort, incidence of severe PVS was <1% and incidence of symptomatic PVS necessitating intervention was negligible. Based on these findings, it seems appropriate to only screen for PVS in patients with suggestive symptoms.

Cited by 60 publications

References 29 publications

Radiofrequency Catheter Ablation: How to Manage and Prevent Collateral Damage?

Radiofrequency Catheter Ablation: How to Manage and Prevent Collateral Damage?

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

A case of balloon angioplasty guided by integrated backscatter intravascular ultrasound for the treatment of pulmonary vein stenosis caused by radiofrequency atrial fibrillation

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