Pulmonary Vein Stenosis After Atrial Fibrillation Ablation: Insights From the ADVICE Trial

Michelle Samuel, Paul Khairy, François Pierre Mongeon, Jason G. Andrade, Sophie Gomes, Zurine Galvan, Rukshen Weerasooriya, Paul Novak, Isabelle Nault, Thomas Arentz, Isabel Deisenhofer, George D. Veenhuyzen, Pierre Jaïs, Ratika Parkash, Atul Verma, Syamkumar Menon, Helmut Puererfellner, Christophe Scavée, Mario Talajic, Peter G. GuerraLena Rivard, Marc Dubuc, Katia Dyrda, Bernard Thibault, Blandine Mondesert, Rafik Tadros, Julia Cadrin-Tourigny, Martin Aguilar, Jean Claude Tardif, Sylvie Levesque, Denis Roy, Stanley Nattel, Laurent Macle

Research output: Contribution to journalArticle

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. 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. 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). 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.

Original languageEnglish
Pages (from-to)1965-1974
Number of pages10
JournalCanadian Journal of Cardiology
Volume36
Issue number12
DOIs
Publication statusPublished - Dec 2020

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