Author + information
- Received September 11, 2017
- Revision received October 1, 2017
- Accepted October 3, 2017
- Published online April 16, 2018.
- R. Jay Widmer, MD, PhDa,
- Erin A. Fender, MDa,
- David O. Hodge, MSb,
- Kristi H. Monahan, RNa,
- Lauri A. Petersona,
- David R. Holmes Jr., MDa and
- Douglas L. Packer, MDa,∗ ()
- aDivision of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
- bDepartment of Health Sciences Research, Mayo Clinic and College of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Douglas Packer, Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota.
Objectives This study sought to identify clinical and procedural risk factors associated with pulmonary vein (PV) restenosis.
Background Pulmonary vein stenosis (PVS) is a rare but morbid complication of PV isolation for atrial fibrillation (AF) ablation. Interventions such as PV balloon angioplasty (BA) or stenting achieve excellent acute success; however, subsequent restenosis is common.
Methods A total of 113 patients underwent invasive treatment for severe PVS between 2000 and 2014 and were followed prospectively. Baseline patient and lesion characteristics were abstracted from chart review and analyzed. Univariate and multivariate analyses were performed using patient and procedural characteristics to determine which factors were associated with an increased risk for subsequent PV restenosis.
Results Over a median follow-up of 4.6 years there was PVS recurrence in 75 veins; 52 veins (57%) were treated with index BA and 23 veins were treated with stenting. After multivariate analysis, the only patient factor that was significantly associated with restenosis was a history of more than 1 AF ablation (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.07 to 3.41; p = 0.03). Multivariate analysis on a per-vein level demonstrated a significantly lower risk of restenosis in veins treated with a stent (HR: 2.84; 95% CI: 1.75 to 4.61; p < 0.0001). In veins treated with BA alone, inflation of the balloon to higher atmospheres significantly reduced the risk of recurrence (HR: 0.87; 95% CI: 0.78 to 0.98; p = 0.02).
Conclusions Restenosis is common after a successful PV intervention and the risk of restenosis is highest in those with a history of multiple AF ablations and in those treated with BA. Proceduralists should take into account the number of AF ablations a patient has undergone and should strongly consider stent deployment when intervening on PVS to reduce risk of restenosis.
This study was supported by Nassif Stewardship. Dr. Packer has provided uncompensated consulting services to Abbott, Abiomed, Aperture Diagnostics, Biosense Webster, Boston Scientific, CardioDX, CardioFocus, CardioInsight Technologies, InfoBionic, Johnson & Johnson Healthcare Systems, Johnson & Johnson, MediaSphere Medical, Medtronic CryoCath, Sanofi, Siemens, Spectrum Dynamics, St. Jude Medical, and Topera Medical; and has received research funding from the American Heart Association Foundation Award, Biosense Webster, Boston Scientific/EPT, CardioInsight, CardioFocus, Endosense, EpiEP, EPreward, Hansen Medical, Medtronic CryoCath, National Institutes of Health, St. Jude Medical, and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Widmer and Fender contributed equally to this work.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 11, 2017.
- Revision received October 1, 2017.
- Accepted October 3, 2017.
- 2018 American College of Cardiology Foundation