17-04: Long-term outcome of interventional treatment of pulmonary vein stenosis following radiofrequency catheter ablation of atrial fibrillation

Background: Pulmonary vein (PV) stenosis following catheter ablation of atrial fibrillation is a rare but potentially severe complication. Treatment options include interventional angioplasty with or without stent implantation. However, outcome-data is limited. We report on the long-term results after interventional treatment of patients with symptomatic PV stenosis in our center.

Methods and results: Data of 17 patients (11 male) undergoing PV angioplasty in our clinic were retrospectively analyzed. Data are expressed as mean value ± standard deviation.

Each patient underwent an initial index PV angioplasty, optionally with stent-implantation. Patients had a mean age of 52 ± 12 years, symptoms included dyspnea, hemoptysis and recurrent pneumonia. During the follow-up period, all patients underwent transesophageal echocardiography and PV angiography after 3–6 months and in case of symptom recurrence. Mean follow-up period was 25 ± 29 months.

After initial suspicion of PV stenosis, PV angiography revealed a total of 24 high-degree PV stenoses (11 (46%) left superior PV, 10 (42%) left inferior PV, 1 (4%) right superior PV and 2 (8%) right inferior PV). 11 patients (46%) had 1 high-degree PV stenosis, 4 patients (17%) had 2 stenoses and another 2 patients (8%) had 3 stenoses, respectively. The patients underwent a mean of 1.9 ± 1.3 angioplasties including the index procedure. In total, 18 bare metal stents (BMS) and 17 drug eluting stents (DES) were implanted. Additionaly 5 drug eluting balloon (DEB) angioplasties were performed.

For 7 different PV (29%) multiple angioplasties in case of symptomatic re-stenosis with a mean of 2.0 ± 1.2 repetitive interventions were needed. In 4 cases (57%) of re-stenosis a BMS was implanted in the index procedure, in 3 cases (43%) a DES was implanted initially.

Major complications occured in 2 cases (8%), including a case of pulmonary bleeding after angioplasty of a left inferior PV and a case of PV dissection during stenting of a left inferior PV. Minor complications occured in 2 cases (8%; 1 pericardial effusion without intervention and 1 minor groin complication).

Discussion: We report long-term results after PV angioplasty for iatrogenic PV stenosis in 17 patients. Angioplasty with BMS- and DES-implantation seems to be feasible with a high rate of immediate success and reasonable incidence of complications. Re-stenosis was seen in approximately one third of all treated PV in this patient cohort regardless of the type of stent used in the index procedure.