Iversen Elisabeth, Packer Erik J S, Sandberg Synne M, Bleie Øyvind, Hoff Per Ivar, Schuster Peter
Department of Heart Disease, Haukeland University Hospital, N-5021, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
J Interv Card Electrophysiol. 2018 Dec;53(3):309-315. doi: 10.1007/s10840-018-0370-y. Epub 2018 Apr 18.
Symptomatic severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a rare but well-recognized complication. Treatment options include pulmonary vein angioplasty with or without drug eluting balloons or angioplasty with stent implantation. The treatment of choice is unclear. In our center, pulmonary vein stenting is the treatment of choice for significantly stenotic veins. We present the long-term clinical outcome of 9 patients treated with stent implantation.
Between 2001 and 2015, 3048 patients with AF were treated with catheter ablation at our institution, of which 9 developed symptomatic PVS. A total of 11 PVS were treated. Pre-procedural imaging (CT, MR, transesophageal echocardiography, angiography) was performed in all patients.
Mean time from ablation to stenting was 18 months. Three patients had recurrent pneumonia and the remaining reduced functional capacity (NYHA 2). All patients were in functional capacity NYHA 1 (p < 0.05) after a mean follow-up of 64 (18-132) months. Three patients still had paroxysmal AF, of which two have undergone repeated ablation.
Symptomatic PVS after AF ablation can be successfully treated by stent implantation with durable results and good clinical outcome. AF ablation is still a feasible option after stent deployment.
心房颤动（AF）导管消融术后出现症状性严重肺静脉狭窄（PVS）是一种罕见但已被充分认识的并发症。治疗选择包括使用或不使用药物洗脱球囊的肺静脉血管成形术或支架植入血管成形术。首选治疗方法尚不清楚。在我们中心，肺静脉支架置入术是严重狭窄静脉的首选治疗方法。我们报告了9例接受支架植入治疗患者的长期临床结果。
2001年至2015年期间，我们机构对3048例房颤患者进行了导管消融治疗，其中9例出现症状性PVS。共治疗了11处PVS。所有患者均进行了术前影像学检查（CT、MR、经食管超声心动图、血管造影）。
从消融到置入支架的平均时间为18个月。3例患者反复发生肺炎，其余患者功能能力下降（纽约心脏协会2级）。平均随访64（18 - 132）个月后，所有患者的功能能力均为纽约心脏协会1级（p < 0.05）。3例患者仍有阵发性房颤，其中2例接受了再次消融。
房颤消融术后出现的症状性PVS可通过支架植入成功治疗，效果持久，临床结果良好。支架置入后房颤消融仍是一种可行的选择。
