Treating Post-Ablation Pulmonary Vein Stenosis

ABSTRACT

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence is projected to continue to increase over the next few decades in correlation with the aging population. Transcatheter isolation of the pulmonary veins is the most common procedure for AF ablation, and has accordingly been on the rise as well with a 10-fold increase in procedures from 2000 to 2013. Pulmonary vein stenosis is a well-known complication of AF ablation that portends significant morbidity. Its vague and widely variant clinical presentation makes it an oft delayed diagnosis. Diagnostic imaging is crucial in establishing the diagnosis and also provides valuable information for transcatheter procedural planning. The most recent consensus expert statement regarding management of PVS is outdated from 2012, with the addition of a number of publications evaluating transcatheter management options in the interim. While the 2012 guidelines recommend initial management of severe PVS with balloon angioplasty (BA) alone, numerous studies have been released that demonstrate superior long-term outcomes with stenting compared to BA. However, PV stenting in itself is not without risk of restenosis and there is more recent data to suggest that this technique should be reserved for those with a larger reference vessel diameter. The post-intervention management of these patients has not been well studied as of yet, and the optimal antithrombotic regimen and duration are not evidence-based at this point. Herein we aim to provide a comprehensive overview of the diagnosis and management of PVS, focusing on transcatheter therapies.

KEYWORDS:

• Pulmonary vein stenosis
• pulmonary vein isolation
• transcatheter therapies

Disclosure statement

Laura Young has no conflict of interest; Amar Krishnaswamy has no conflict of interest; Samir Kapadia has no conflict of interest.