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e0489 Pulmonary vein stenting for the treatment of acquired severe pulmonary vein stenosis complicating ablation for atrial fibrillation

Introduction Ablation procedures for atrial fibrillation (AF) are being performed with increasing frequency. One of the most serious complications is the development of pulmonary vein stenosis, which occurs in 1% to 3% of current series. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is still uncertain in China. The aim of this study was the evaluation of the short-term success and safety after PV stenting of severe stenosis. Methods and results 5 patients (pts) with 11 PVS were prospectively evaluated. All 5 pts experienced onset of dyspnoea on exertion some weeks or several months before, 3 with dyspnoea at rest, 5 with cough, and 2 with chest pain. On multirow spiral CT examination for each case, the narrowest lumen of the affected PVs measured 2±1.1 mm compared with 10±1.3 mm at baseline (p≦0.001). The length of narrow segment was 10±2.9mm. All of 11 veins were treated with stent implantation with Palmaz Genesis stents, which size were 7- or 8-mm-diameter and 12 -, 15-, 18 -mm-length. At percutaneous intervention, these veins showed 81±13% stenosis, with a mean gradient of 20±5 mm Hg. This was significantly reduced to a residual stenosis of 8±2% (p≤0.001) and a residual gradient of 3±2 mm Hg (p≤0.001) immediately. The mean pulmonary pressure was 46±5 mm Hg pre-intervention, which decreased to 28±4 mm Hg post-intervention in our protocols. The procedure was safety and successful, no complications were occurred in our pts. The symptomatic response was improved immediately and significantly. Conclusions Percutaneous intervention produces rapid and dramatic symptom relief in patients with highly symptomatic PV stenosis after radiofrequency ablation for AF. Nevertheless, mid-term and long-term follow-up study with flow determination in the affected vein is still need to assess.