Pulmonary Vein Stenting for the Treatment of Acquired Severe Pulmonary Vein Stenosis after Pulmonary Vein Isolation: Clinical Implications after Long-Term Follow-Up of 4 Years
Authors: NEUMANN, THOMAS; KUNISS, MALTE; CONRADI, GUIDO; SPERZEL, JOHANNES; BERKOWITSCH, ALEXANDER; ZALTSBERG, SERGEY; WOJCIK, MACIEJ; ERKAPIC, DAMIR; DILL, THORSTEN; HAMM, CHRISTIAN W.; PITSCHNER, HEINZ-F.
Source: Journal of Cardiovascular Electrophysiology, Volume 20, Number 3, March 2009 , pp. 251-257(7)
Abstract:Pulmonary Vein Stenting.
Introduction: Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well-recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44–70%. Whether there is additional long-term benefit from PVS stenting is uncertain. The aim of this study was the evaluation of the long-term success after PV stenting of severe stenosis.
Methods and Results: Ten patients (pts) with 13 PVS were prospectively evaluated. PV stenting was performed with Palmaz Genesis stents. Magnetic resonance imaging (MRI), lung perfusion scans, and CT-scans were performed before, directly after, and every 12 months thereafter. Primary endpoint of the study was the occurrence of restenosis after PV stenting. After a median follow-up of 47.7 (IQRs 25/75 47.2–48.5) months, the primary endpoint was achieved in 3 out of 13 PVs (23% of the treated PVs). We observed two in-stent restenosis 2 and 4 years after PV stenting. These pts experienced onset of dyspnea some weeks before. After an additional balloon angioplasty, the in-stent restenosis was resolved. In one asymptomatic patient, we observed an occlusion of the PV stent 13 months poststenting. Normalization of lung perfusion was noted 4 years after PV stenting versus directly poststenting in all pts without in-stent restenosis (n = 7).
Conclusion: PVS stenting with stent sizes ≥10 mm seems to be an adequate therapy modality for treatment of severe acquired PVS. Late in-stent restenosis after PVS stenting can occur. The normalization of the initially disturbed lung perfusion scan is possible and remains stable, even 4 years after PVS stenting.
(J Cardiovasc Electrophysiol, Vol. 20, pp. 251-257, March 2009)
Document Type: Research Article
Affiliations: From the Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
Publication date: March 1, 2009
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- In this Subject: Cardiovascular Medicine
- By this author: NEUMANN, THOMAS ; KUNISS, MALTE ; CONRADI, GUIDO ; SPERZEL, JOHANNES ; BERKOWITSCH, ALEXANDER ; ZALTSBERG, SERGEY ; WOJCIK, MACIEJ ; ERKAPIC, DAMIR ; DILL, THORSTEN ; HAMM, CHRISTIAN W. ; PITSCHNER, HEINZ-F.