open access

Vol 26, No 5 (2019)
Original articles — Interventional cardiology
Published online: 2018-09-20
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Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

Katharina Schoene, Arash Arya, Cosima Jahnke, Ingo Paetsch, Nikolaos Dagres, Andreas Bollmann, Gerhard Hindricks, Philipp Sommer
DOI: 10.5603/CJ.a2018.0114
·
Pubmed: 30246235
·
Cardiol J 2019;26(5):451-458.

open access

Vol 26, No 5 (2019)
Original articles — Interventional cardiology
Published online: 2018-09-20

Abstract

Background: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience.


Methods: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B).


Results: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found.

Conclusions: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS
is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.

Abstract

Background: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience.


Methods: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B).


Results: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found.

Conclusions: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS
is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.

Get Citation

Keywords

pulmonary vein stenosis; radiofrequency ablation; atrial fibrillation; electroanatomical mapping system

About this article
Title

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

Journal

Cardiology Journal

Issue

Vol 26, No 5 (2019)

Pages

451-458

Published online

2018-09-20

DOI

10.5603/CJ.a2018.0114

Pubmed

30246235

Bibliographic record

Cardiol J 2019;26(5):451-458.

Keywords

pulmonary vein stenosis
radiofrequency ablation
atrial fibrillation
electroanatomical mapping system

Authors

Katharina Schoene
Arash Arya
Cosima Jahnke
Ingo Paetsch
Nikolaos Dagres
Andreas Bollmann
Gerhard Hindricks
Philipp Sommer

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