Antithrombotic therapy after angioplasty of pulmonary vein stenosis due to atrial fibrillation ablation: A two‐center experience and review of the literature. Issue 6 (12th September 2022)

• Record Type: Journal Article
• Authors: Fink, Thomas; Vogler, Julia; Proietti, Riccardo; Sciacca, Vanessa; Heeger, Christian‐Hendrik; Rottner, Laura; Maurer, Tilman; Metzner, Andreas; Mathew, Shibu; Eitel, Charlotte; Eitel, Ingo; Sohns, Christian; Sano, Makoto; Reissmann, Bruno; Rillig, Andreas; Ouyang, Feifan; Kuck, Karl‐Heinz; Tilz, Roland Richard
• Is Part Of: Journal of arrhythmia. Volume 38:Issue 6(2022)
• Page Start: 1009
• Page End: 1016
• Publication Date: 2022-09-12
• Subjects: anticoagulation -- antiplatelet therapy -- atrial fibrillation -- pulmonary vein stenosis; restenosis -- triple therapy; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12777
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: Pulmonary vein stenosis (PVS) is a severe complication of atrial fibrillation (AF) ablation resulting in narrowing of affected pulmonary veins (PVs). Interventional treatment consists of angioplasty with or without PV stenting. The optimal postprocedural antithrombotic therapy is not known. Study aims: To investigate the impact of antithrombotic medical therapy on recurrence of PVS after PV angioplasty. Methods: A retrospective study of patients undergoing PV angioplasty with or without stent implantation in two German centers was performed. Postinterventional antithrombotic therapy consisted of either dual antiplatelet therapy (DAPT) or a combination of oral anticoagulation with single or dual antiplatelet therapy for 3–12 months after intervention. Angiographic follow‐up was recommended 3, 6, and 12 months after intervention and in case of symptom recurrence. Results: Thirty patients underwent treatment of 42 PVS. After intervention, twenty‐eight patients received triple therapy and 14 patients received dual therapy/DAPT; restenosis occurred in 5/22 (22.7%) patients with triple therapy and 8/14 (57.1%) patients with dual therapy/DAPT PV ( p = .001). Estimated freedom from PV restenosis after 500 days was 18.8 ± 15.8% (dual therapy/DAPT) and 76.2 ± 10.5% (triple therapy) ( p = .003). Univariate regression analysis revealed postprocedural medication as a significant risk factor for restenosis ( p = .019). No bleeding events occurred regardless of applied antithrombotic therapy. Conclusion: Triple antithrombotic therapy after PV angioplasty is associated with less frequent restenosis as compared to dual antiplatelet therapy or a combination of anticoagulation and single antiplatelet therapy. No severe bleeding events occurred in patients on triple therapy. These findings need to be confirmed in larger patient cohorts. Abstract : The current study analyzed medical antithrombotic therapy in patients undergoing angioplasty of pulmonary vein stenosis related to atrial fibrllation ablation. The study found significant longer re‐stenosis‐free survival in patients on triple anti‐thrombotic therapy with anticoagulation and dual anti‐platelet therapy as compared to patients on dual anti‐thrombotic therapy with anticoagulation and single anti‐platelet therapy withoout occurrence of serious bleeding events in any patient. The study results point to a potential use of triple anti‐thrombotic therapy in patients undergoing pulmonary vein stenosis angioplasty.