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Pulmonary Vein Stenosis After Atrial Fibrillation Ablation: Insights From the ADVICE Trial.
- Source :
-
The Canadian journal of cardiology [Can J Cardiol] 2020 Dec; Vol. 36 (12), pp. 1965-1974. Date of Electronic Publication: 2020 Nov 03. - Publication Year :
- 2020
-
Abstract
- Background: Pulmonary vein (PV) stenosis is a complication of atrial fibrillation (AF) ablation. The incidence of PV stenosis after routine post-ablation imaging remains unclear and is limited to single-centre studies. Our objective was to determine the incidence and predictors of PV stenosis following circumferential radiofrequency ablation in the multicentre Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination (ADVICE) trial.<br />Methods: Patients with symptomatic AF underwent circumferential radiofrequency ablation in one of 13 trial centres. Computed tomographic (CTA) or magnetic resonance (MRA) angiography was performed before ablation and 90 days after ablation. Two blinded reviewers measured PV diameters and areas. PVs with stenosis were classified as severe (> 70%), moderate (50%-70%), or mild (< 50%). Predictors of PV stenosis were identified by means of multivariable logistic regression.<br />Results: A total of 197 patients (median age 59.5 years, 29.4% women) were included in this substudy. PV stenosis was identified in 41 patients (20.8%) and 47 (8.2%) of 573 ablated PVs. PV stenosis was classified as mild in 42 PVs (7.3%) and moderate in 5 PVs (0.9%). No PVs had severe stenosis. Both cross-sectional area and diameter yielded similar classifications for severity of PV stenosis. Diabetes was associated with a statistically significant increased risk of PV stenosis (OR 4.91, 95% CI 1.45-16.66).<br />Conclusions: In the first systematic multicentre evaluation of post-ablation PV stenosis, no patient acquired severe PV stenosis. Although the results are encouraging for the safety of AF ablation, 20.8% of patients had mild or moderate PV stenosis, in which the long-term effects are unknown.<br /> (Copyright © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Canada epidemiology
Catheter Ablation methods
Computed Tomography Angiography methods
Computed Tomography Angiography statistics & numerical data
Female
Humans
Incidence
Male
Middle Aged
Organ Size
Outcome Assessment, Health Care
Risk Factors
Severity of Illness Index
Atrial Fibrillation diagnosis
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Magnetic Resonance Angiography methods
Magnetic Resonance Angiography statistics & numerical data
Postoperative Complications diagnosis
Postoperative Complications epidemiology
Postoperative Complications physiopathology
Pulmonary Veins diagnostic imaging
Pulmonary Veins pathology
Pulmonary Veins surgery
Stenosis, Pulmonary Vein diagnosis
Stenosis, Pulmonary Vein epidemiology
Stenosis, Pulmonary Vein etiology
Stenosis, Pulmonary Vein physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1916-7075
- Volume :
- 36
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The Canadian journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 33157186
- Full Text :
- https://doi.org/10.1016/j.cjca.2020.10.013