Contributors Toward Pulmonary Vein Restenosis Following Successful Intervention

• Published in: JACC. Clinical electrophysiology Vol. 4; no. 4; pp. 547 - 552
• Main Authors: Widmer, R. Jay, Fender, Erin A., Hodge, David O., Monahan, Kristi H., Peterson, Lauri A., Holmes, David R., Packer, Douglas L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2018
• Subjects: atrial fibrillation; intervention; pulmonary vein isolation; pulmonary vein stenosis; CT; atrial fibrillation; AF; CI; PV; HR; intervention; pulmonary vein stenosis; PVS; pulmonary vein isolation; BA
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2017.10.001

This study sought to identify clinical and procedural risk factors associated with pulmonary vein (PV) restenosis.
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.
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.
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).
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.
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