Pulmonary Vein Stenosis After Atrial Fibrillation Ablation: Insights From the ADVICE Trial

Samuel, Michelle; Khairy, Paul; Mongeon, François Pierre; Andrade, Jason G.; Gomes, Sophie; Galvan, Zurine; Weerasooriya, Rukshen; Novak, Paul; Nault, Isabelle; Arentz, Thomas; Deisenhofer, Isabel; Veenhuyzen, George D.; Jaı̈s, Pierre; Parkash, Ratika; Menon, Syamkumar M. Divakara; Püererfellner, Helmut; Scavée, Christophe; Talajic, Mario; Guerra, Peter G.; Rivard, Léna; Dubuc, Marc; Dyrda, Katia; Thibault, Bernard; Mondésert, Blandine; Tadros, Rafik; Cadrin‐Tourigny, Julia; Aguilar, Martín; Tardif, Jean‐Claude; Lévesque, Sylvie; Roy, Denis; Nattel, Stanley; Macle, Laurent

doi:10.1016/j.cjca.2020.10.013

Cited by 18 publications

(29 citation statements)

References 30 publications

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“…A previous multicenter study demonstrated that moderate PVS after circumferential RF-PVI was identified in 0.9% of PVs and that none of the PVs had severe stenosis. 18 In the current study, the incidence of moderate and severe PVS after CB-PVI was 5.3% and 0.5%, respectively, which is consistent with previous reports. 7-9 As was observed for RF-PVI, a more proximal PVI is desirable for preventing PVS.…”

Section: Incidence Of Pvssupporting

confidence: 92%

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

Tokuda

Yamashita

Shiomi

et al. 2023

Circ J

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Background: Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI. Methods and Results:A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient. Conclusions:Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.

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Section: Incidence Of Pvssupporting

confidence: 92%

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

Tokuda

Yamashita

Shiomi

et al. 2023

Circ J

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“…De Greef et al [ 20 ] reported permanent pulmonary vein stenosis in only 0.003% of cases after catheter ablations. On the other hand, Samuel et al [ 54 ] conducted a multicenter, single-blind, randomized, controlled trial to determine the incidence of pulmonary vein stenosis after catheter ablation. When they performed 197 computed tomographic or magnetic resonance angiographies, pulmonary vein stenosis was identified in 20.8% of patients and 8.2% of ablated pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

The Minimum Number of Ablation Lines for Complete Isolation of the Pulmonary Veins during Thoracoscopic Ablation for Atrial Fibrillation

Choi

Lee

Jeong

2023

Life

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Total thoracoscopic ablation has been recommended as a class IIa indication for atrial fibrillation. However, the optimal number of ablation lines for pulmonary vein isolation has not yet been proposed. This study aimed to report the minimum number of ablation lines required to achieve an intraoperative conduction block. This study included a total of 20 patients who underwent total thoracoscopic ablation from December 2020 to July 2021. The epicardial conduction block was checked after each ablation line of pulmonary vein antral clamping. The median age was 61 years old. The median duration of atrial fibrillation since the first diagnosis was 78 months. Pulmonary vein isolation with bidirectional conduction block was confirmed in 90% of patients. A median of six ablation lines around each pulmonary vein antrum were performed according to our protocol even after the conduction block was verified. The median number of ablations to achieve an exit block was two on the right side and 3.5 on the left side. We found that most conduction blocks were achieved within three ablations around the pulmonary vein antrum. Our results may provide evidence to reduce the number of unnecessary ablation lines in the future.

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“…[18,19] Alternatively, there may be prenatal substrates for stenosis that become more evident in response to various causes, resulting in the observation of apparent "acquired" stenosis, allowing certain CPVS to be categorized as APVS. [51] However, in adults, PVS is most common after pulmonary vein isolation (PVI) [29,52] and in fibrosing mediastinitis (FM), followed by tumors, neoplasm growth, sarcoidosis, etc. [32,[53][54][55]…”

Section: Acquired Pulmonary Vein Stenosismentioning

confidence: 99%

Pulmonary Vein Stenosis: A Review

Jia

Wang

et al. 2023

Cardiology Discovery

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Pulmonary vein stenosis (PVS) is an extremely rare and lethal disease caused by multiple etiologies. PVS has a bimodal distribution in the population, affecting children and adults. Congenital PVS is the usual PVS type in children, which sometimes develops after cardiothoracic surgery. Acquired PVS, in turn, is the most common PVS type in adults. A review of the relevant literature has shown that PVS after radiofrequency ablation of atrial fibrillation is the most common, as well as that caused by compression of proliferative fibrous tissues or tumor in the mediastinum (eg, PVS caused by fibrosing mediastinitis, lung tumors, metastases, etc). This article provides a comprehensive review of PVS in terms of embryology and anatomy, etiology and triggers, classification, clinical symptoms and signs, treatment, and prognosis, intending to promote the understanding and treatment of this disease.

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Pulmonary Vein Stenosis After Atrial Fibrillation Ablation: Insights From the ADVICE Trial

Cited by 18 publications

References 30 publications

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

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

The Minimum Number of Ablation Lines for Complete Isolation of the Pulmonary Veins during Thoracoscopic Ablation for Atrial Fibrillation

Pulmonary Vein Stenosis: A Review

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