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

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Symptomatic pulmonary vein stenosis (sPVS) is a severe complication of atrial fibrillation (AF) ablation.
• High-power, short-duration (HPSD) and very HPSD (vHPSD) radiofrequency (RF) ablation techniques offer procedural efficiency but may pose a risk for sPVS.
• Previous reports suggest HPSD may be a risk factor for sPVS.

Purpose of the Study:

• To compare the incidence of sPVS following RF AF ablation using HPSD, vHPSD, and standard-power long-duration (SPLD) approaches.
• To identify potential risk factors for sPVS development after AF ablation.

Main Methods:

• A multicenter, observational analysis of 436 patients undergoing RF AF ablation.
• Patients were categorized into three groups based on ablation strategy: HPSD (n=64), vHPSD (n=71), and SPLD (n=301).
• The incidence of sPVS was assessed during a median follow-up of 20 months.

Main Results:

• No significant differences in baseline characteristics were observed between groups.
• Nine cases of sPVS were identified: 7 (10.9%) in the HPSD group, 1 (1.4%) in the vHPSD group, and 1 (0.3%) in the SPLD group (p < 0.001).
• HPSD ablation was an independent predictor of sPVS (hazard ratio, 20.226; p = 0.005). Seven patients required percutaneous intervention.

Conclusions:

• RF AF ablation using the HPSD approach may be associated with an increased risk of sPVS.
• The vHPSD approach showed a similar low incidence of sPVS compared to the SPLD approach.
• These findings suggest a need for careful consideration of ablation strategies to minimize sPVS risk.