Complex cases of acquired pulmonary vein stenosis after radiofrequency ablation: is surgical repair an option?

Schoene, Katharina; Sommer, Philipp; Arya, Arash; Kostelka, Martin; Mohr, Friedrich W.; Misfeld, Martín; Vollroth, Marcel; Bollmann, Andreas; Lurz, Julia; Hindricks, Gerhard

doi:10.1093/europace/euy017

Cited by 15 publications

(13 citation statements)

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“…Severe symptoms such as dyspnea and hemoptysis may occur. Catheter-based interventional treatment for PVS still remains a challenging field [3,[5][6][7][8][9]. To improve anatomical understanding and to reduce radiation exposure during ablation procedures, electroanatomical mapping systems (EAMS) were introduced [10].…”

Section: Introductionmentioning

confidence: 99%

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

et al. 2019

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Background: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. Methods: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). Results: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO ® , 48/4510 (1.1%) using EnSite ® , 1/853 (0.1%) using MediGuide ® , and 1/162 (0.6%) using Rhythmia ®. Since 2009, no significant difference between technologies was found. Conclusions: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.

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Section: Introductionmentioning

confidence: 99%

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

et al. 2019

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“…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%

“…5,6 We also reported our experience in catheter intervention as well as surgical treatment of PVS with the lowest rate of restenosis after stent implantation. 5,7 However, another pertinent question is regarding the natural course of PVS over a long-term period of years. Do we have to consider special follow-up visits or follow-up imaging in these patients?…”

Section: Introductionmentioning

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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“…However, successful application of a percutaneous procedure depends on the location and severity of the occlusion, and pulmonary restenosis is a common complication. Since most PVOs are managed percutaneously, expertise regarding surgical repair of acquired PVO is limited, and restenosis of the pulmonary vein remains a feared complication . Successful reconstruction of the pulmonary vein has previously been described using a pericardium or polytetrafluoroethylene patch .…”

Section: Introductionmentioning

confidence: 99%

“…Since most PVOs are managed percutaneously, expertise regarding surgical repair of acquired PVO is limited, and restenosis of the pulmonary vein remains a feared complication. 9 Successful reconstruction of the pulmonary vein has previously been described using a pericardium or polytetrafluoroethylene patch. 10 Nevertheless, the patches can be difficult to fashion correctly and may distort the pulmonary artery, shrink, or calcify.…”

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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Complex cases of acquired pulmonary vein stenosis after radiofrequency ablation: is surgical repair an option?

Cited by 15 publications

References 14 publications

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

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

Repair of iatrogenic pulmonary vein occlusion with a vascularized atrial flap

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