Antithrombotic therapy after angioplasty of pulmonary vein stenosis due to atrial fibrillation ablation: A two‐center experience and review of the literature

  • Thomas Fink
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Julia Vogler
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Riccardo Proietti
    Department of Cardiac, Thoracic, and Vascular Sciences University of Padua Padua Italy
  • Vanessa Sciacca
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Christian‐Hendrik Heeger
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Laura Rottner
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Tilman Maurer
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Andreas Metzner
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Shibu Mathew
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Charlotte Eitel
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Ingo Eitel
    University Heart Centre Lübeck, Department of Cardiology, Angiology, and Intensive Care Medicine University Hospital Schleswig‐Holstein Lübeck Germany
  • Christian Sohns
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Makoto Sano
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Bruno Reissmann
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Andreas Rillig
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Feifan Ouyang
    Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
  • Karl‐Heinz Kuck
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
  • Roland Richard Tilz
    University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Study aims</jats:title><jats:p>To investigate the impact of antithrombotic medical therapy on recurrence of PVS after PV angioplasty.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 (<jats:italic>p</jats:italic> = .001). Estimated freedom from PV restenosis after 500 days was 18.8 ± 15.8% (dual therapy/DAPT) and 76.2 ± 10.5% (triple therapy) (<jats:italic>p</jats:italic> = .003). Univariate regression analysis revealed postprocedural medication as a significant risk factor for restenosis (<jats:italic>p</jats:italic> = .019). No bleeding events occurred regardless of applied antithrombotic therapy.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>

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