Incidence of Pulmonary Vein Stenosis in Patients Submitted to Atrial Fibrillation Ablation: A Comparison of the Selective Segmental Ostial Ablation vs the Circumferential Pulmonary Veins Ablation

Tamborero, David; Mont, Lluı́s; Nava, Santiago; Caralt, Teresa M. de; Molina, Irma; Scalise, Andrea; Perea, Rosario J.; Bartholomay, Eduardo; Berruezo, Antonio; Matiello, María; Brugada, Josep

doi:10.1007/s10840-005-4513-6

Cited by 43 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its nature seems to be transient as documented in 69% of cases. This finding is consistent with Doppler data showing some degree of narrowing after the procedure that did not predict development of significant stenoses in long-term follow-up [21,22]. However, these results are contradictory to MRA data by Berkowitsch et al [25], who showed that minimal PV diameter reduction 1 day after ablation predicted development of significant stenosis in the long-term.…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

et al. 2006

View full text Add to dashboard Cite

One of the recognised complications of catheter ablation is pulmonary venous stenosis. The aim of this study was to compare two methods of evaluation of pulmonary venous diameter for follow-up assessment of the above complication: (1) a linear approach evaluating two main diameters of the vein, (2) semiautomatically measured cross-sectional area (CSA). The study population consists of 29 patients. All subjects underwent contrast-enhanced magnetic resonance angiography (CeMRA) of the pulmonary veins (PVs) before and after the ablation; 14 patients were also scanned 3 months later. PV diameter was evaluated from two-dimensional multiplanar reconstructions by measuring either the linear diameter or CSA. A comparison between pulmonary venous CSA and linear measurements revealed a systematic difference in absolute values. This difference was not significant when comparing the relative change CSA and quadratic approximation using linear extents (linear approach). However, a trend towards over-estimation of calibre reduction was documented for the linear approach. Using CSA assessment, significant PV stenosis was found in ten PVs (8%) shortly after ablation. Less significant PV stenosis, ranging from 20 to 50% was documented in other 18 PVs (15%). CeMRA with CSA assessment of the PVs is suitable method for evaluation of PV diameters.

show abstract

Section: Discussionsupporting

confidence: 85%

“…There is mounting evidence that the incidence of severe PV stenosis is declining with ablation strategies focused primarily on circumferential ablation around the ostia [12,21]. Some authors suggest that power titration using intracardiac echocardiography may further decrease the risk of this complication [12].…”

Section: Discussionmentioning

confidence: 99%

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In addition, 1 CPVA-1 and 2 CPVA-2 patients had postprocedural pericarditis that required nonsteroidal antiinflammatory treatment. Magnetic resonance angiogram performed before and 4 months after ablation in all patients of this series did not reveal any severe (Ͼ70%) PV stenosis 15 ; one patient of the CPVA-2 group showed a left superior PV narrowing of 55%.…”

Section: Tamborero Et Al Isolation Of the La Posterior Wall In Af Ablmentioning

confidence: 60%

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Tamborero

Mont

Berruezo

et al. 2009

Circ: Arrhythmia and Electrophysiology

Self Cite

135

115

View full text Add to dashboard Cite

Background-Ablation of the pulmonary veins (PVs) for atrial fibrillation treatment is often combined with linear radiofrequency lesions along the left atrium (LA) to improve the success rate. The study was designed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation (CPVA). Methods and Results-CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus. Patients were then randomized into 2 groups. In the first group, superior PVs were connected by linear lesions along the LA roof (CPVA-1 group). In the second group, the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the 2 inferior PVs (CPVA-2 group). The study included 120 patients (53Ϯ11 years, 77% male, 60% paroxysmal atrial fibrillation, LA of 41.3Ϯ5.4 mm, 46% with hypertension, and 22% with structural heart disease). After a single ablation procedure and a mean follow-up of 10Ϯ4 months, 24 (40%) patients of the CPVA-1 group had atrial fibrillation recurrences and 3 (5%) had new-onset LA flutter. In the CPVA-2 group, recurrences were due to atrial fibrillation episodes in 23 patients (38%) and LA flutter in 4 (7%). Freedom from arrhythmia recurrences was not statistically different in the CPVA-1 group as compared with the CPVA-2 group (log rank Pϭ0.943). Conclusion-Isolation

show abstract

“…3 It also has the advantage of limiting PV stenosis. 23 While isolation of the PV antra has become the cornerstone of all contemporary AF ablation procedures, patients with more advanced forms of AF, e.g. persistent rather than paroxysmal AF, are known to be less dependent on the PV antra for arrhythmia initiation and perpetuation.…”

Section: Pathophysiology Of Atrial Fibrillation and Atrial Fibrillatimentioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

show abstract

Incidence of Pulmonary Vein Stenosis in Patients Submitted to Atrial Fibrillation Ablation: A Comparison of the Selective Segmental Ostial Ablation vs the Circumferential Pulmonary Veins Ablation

Abstract: PV stenosis is a potential complication of SSOA not seen in CPVA. The study confirms than MRA is useful for identifying patients with asymptomatic PV stenosis.

Cited by 43 publications

References 19 publications

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Pharmacological Tests in Atrial Fibrillation Ablation

Contact Info

Product

Resources

About