Abstract 14782: Incidence and Characteristics of Pulmonary Vein Stenosis Following Catheter Ablation of Atrial Fibrillation: Insights From the Contemporary Multicenter ADVICE Trial
Introduction: Pulmonary vein (PV) stenosis is a well-described complication of atrial fibrillation (AF) ablation. Available data regarding the incidence of pulmonary vein (PV) stenosis associated with radiofrequency catheter ablation of AF are limited to surveys, single-center studies, and small trials. We prospectively assessed the incidence of PV stenosis after catheter ablation of AF in the context of a large randomized multicenter international study (ADVICE).
Methods: Patients undergoing a first PV isolation procedure for the treatment of symptomatic paroxysmal AF were enrolled from 13 centers. PV isolation was performed by encircling all PVs using an irrigated-tip radiofrequency ablation catheter guided by a circular mapping catheter with the endpoint of electrical PV isolation. Systematic imaging of the left atrium and PVs using computed tomography-scan (CT-Scan) or magnetic resonance (MRI) was performed at 90 days post ablation to assess the incidence of PV stenosis. Significant PV stenosis was defined by a narrowing of PV luminal diameter greater than 70% as per Heart Rhythm Society guidelines. The incidence of moderate PV stenosis defined by a narrowing between 50% and 70% was also analyzed. Predictors of PV stenosis were explored by logistic regression analyses.
Results: A total of 197 patients (mean age 59±9 yrs, 71% male) were included in this study. Electrical PV isolation was achieved in all patients. On the post ablation imaging study (performed at a mean of 103±33 days post ablation), a significant PV stenosis was observed in 1.52% [95% confidence interval (0.00%-3.23%)] of patients. In addition, a moderate PV stenosis was seen in 3.55% [95% confidence interval (0.97%-6.14%)] of patients. The affected PVs included 8 left inferior PVs, 1 right inferior and 1 right middle PV. None of the patients were symptomatic or required an intervention related to the PV stenosis. The presence of PV stenosis could not be predicted by clinical, hemodynamic, or procedural parameters.
Conclusions: Our systematic evaluation of the incidence of PV stenosis in the context of a prospective multinational trial confirms previously reported low rates of significant PV stenosis following radiofrequency catheter ablation of AF.
Author Disclosures: S. Gomes: Other Research Support; Significant; Groupe de Rythmologie et de Stimulation Cardiaque de la Société Française de Cardiologie. P. Khairy: None. J. Andrade: None. S. Nattel: None. M. Talajic: None. P. Guerra: None. L. RIvard: None. M. Dubuc: None. K. Dyrda: None. B. Thibault: None. B. Montdesert: None. S. Levesque: None. R. Tadros: None. N. Malliet: None. S. Venier: None. C. Millette: None. D. Roy: None. L. Macle: None.
- © 2014 by American Heart Association, Inc.