[Pulmonary vein stenting for the treatment of severe pulmonary vein stenosis after catheter ablation of atrial fibrillation].

OBJECTIVE: To evaluate the feasibility, safety, and effectiveness of pulmonary vein stenting in patients with severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF).

METHODS: This retrospective analysis included 5 PVS patients (3 males, (54.1 ± 11.2) years old) confirmed by computed tomography angiography after catheter ablation of AF in Shanghai Chest Hospital from April 2010 to April 2013. After selective pulmonary vein angiography, stents were implanted in the pulmonary vein. Operation results were analyzed after the procedure.

RESULTS: All of 14 serious pulmonary vein stenosis from these 5 patients were treated with primary stent implantation (diameter: 7 or 8 mm, length: 12-23 mm). After stenting, degree of pulmonary vein stenosis decreased from (83 ± 16) % to (12 ± 4) % (P < 0.01), the minimal diameter of the stenosis was significantly increased from (1.7 ± 0.6) mm to (8.1 ± 0.7) mm (P < 0.01), trans-stenotic gradient decreased from (15 ± 5) mmHg (1 mmHg = 0.133 kPa) to (3 ± 2) mmHg (P < 0.05), mean pulmonary pressure measured by cardiac catheter decreased from (47 ± 5) mmHg to (28 ± 4) mmHg (P < 0.05). Dyspnea was improved after the procedure. There was no serious operation related complications. Six months after stenting, three patients still complained mild to moderate dyspnea, and in-stent restenosis was evidenced in seven pulmonary veins by computed tomography angiography. These stenosis was successfully dilated by repeated interventions with balloon dilation.

CONCLUSIONS: Stenting for severe pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation may be feasible and safe, and can improve hemodynamics and symptoms. In-stent stenosis is relatively frequent, and larger stents and early intervention may reduce the rates of in-stent restenosis.