Risk of Symptomatic Pulmonary Vein Stenosis After Atrial Fibrillation Ablation With High-Power Short-Duration Approach.

Background: Symptomatic pulmonary vein stenosis (sPVS) is a rare but severe complication of transcatheter atrial fibrillation (AF) ablation. High-power, short-duration (HPSD) and very HPSD (vHPSD) approaches for radiofrequency (RF) AF ablation have been shown to improve procedural efficiency, with effectiveness and a short-term safety profile comparable to conventional standard-power long-duration (SPLD) ablation. Findings from some previous reports suggest that HPSD may be a risk factor for the development of sPVS. The aim of this multicenter, observational analysis was to compare the incidence of sPVS after AF ablation with HPSD, vHPSD, and SPLD.

Methods: Data from 436 consecutive patients (63.1 ± 9.5 years, 66.5% male, 70.9% with paroxysmal AF) undergoing RF AF ablation were reviewed: 64 were ablated with HPSD, 71 with vHPSD, and 301 with SPLD. The incidence of sPVS during follow-up was assessed.

Results: There were no significant differences in baseline characteristics between the three groups. During a median follow-up of 20 months, 9 cases of sPVS were identified: 7 (10.9%) in HPSD group, 1 (1.4%) in vHPSD group, and 1 (0.3%) in SPLD group (p < 0.001). The use of HPSD approach was an independent predictor of sPVS (hazard ratio, 20.226; 95% confidence interval, 20.49-164.59; p = 0.005) on multivariable analysis. Seven of 9 patients underwent percutaneous PVs angioplasty and stent implantation (3 veins in 4 patients, 2 veins in 2 patients, 1 vein in 1 patient).

Conclusions: The results of this observational analysis suggest that RF AF ablation using HPSD approach may be associated with an increased risk of sPVS.