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JACC. Cardiovascular Interventions Jul 2022
Topics: Angioplasty, Balloon; Humans; Mediastinitis; Pulmonary Artery; Pulmonary Veins; Treatment Outcome
PubMed: 35863807
DOI: 10.1016/j.jcin.2022.04.008 -
The American Journal of Case Reports Jul 2022BACKGROUND Pulmonary vein isolation is a method of cardiac ablation therapy used to treat irregular heart rhythm, including atrial fibrillation (AF). This report...
BACKGROUND Pulmonary vein isolation is a method of cardiac ablation therapy used to treat irregular heart rhythm, including atrial fibrillation (AF). This report presents a case of esophagopericardial fistula (EPF) and pneumopericardium as a complication of pulmonary vein isolation in a 62-year-old man with AF. CASE REPORT We report the rare case of a 62-year-old man with a medical history of persistent atrial fibrillation status after ablation 3 days prior to his initial Emergency Department visit for chest pain. Acute coronary syndrome was ruled out with normal electrocardiogram, echocardiography, and troponin tests. Fluid overload and sotalol adverse effects were presumed to be the cause of his symptoms. We discontinued sotalol with diuresis and he was discharged home when his chest pain subsided. Nine days later, he returned to the Emergency Department with worsening similar symptoms and was eventually diagnosed with EPF and pneumopericardium on a computed tomography scan of the chest with contrast. He was managed with esophagogastroduodenoscopy and stent placement along with subxiphoid pericardial window and pericardial drain placement. The patient was discharged in stable condition after removing the pericardial drain. At 10-day and 1-month follow-up, he had no recurrent symptoms. CONCLUSIONS This report shows that although EPF with pneumopericardium is a rare complication of pulmonary vein isolation, it should be rapidly diagnosed and treated as a life-threatening emergency.
Topics: Atrial Fibrillation; Chest Pain; Fistula; Humans; Male; Middle Aged; Pneumopericardium; Pulmonary Veins; Sotalol
PubMed: 35821628
DOI: 10.12659/AJCR.936315 -
Journal of Interventional Cardiac... Jan 2022Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated...
PURPOSE
Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors.
METHODS
The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure.
RESULTS
Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found.
CONCLUSION
Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 33570717
DOI: 10.1007/s10840-021-00944-w -
Journal of Cardiovascular Magnetic... Dec 2022Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including...
BACKGROUND
Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.
METHODS
CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes.
RESULTS
Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen's kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day.
CONCLUSION
Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.
Topics: Humans; Stenosis, Pulmonary Vein; Pulmonary Veins; Catheter Ablation; Constriction, Pathologic; Predictive Value of Tests; Atrial Fibrillation; Lung; Magnetic Resonance Spectroscopy
PubMed: 36503589
DOI: 10.1186/s12968-022-00904-x -
Circulation Journal : Official Journal... Nov 2023Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the...
BACKGROUND
Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI.Methods and Results: A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient.
CONCLUSIONS
Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.
Topics: Humans; Atrial Fibrillation; Stenosis, Pulmonary Vein; Cross-Sectional Studies; Pulmonary Veins; Cryosurgery; Treatment Outcome; Catheter Ablation; Lasers
PubMed: 37258224
DOI: 10.1253/circj.CJ-23-0048 -
JACC. Clinical Electrophysiology Jul 2022
Topics: Atrial Fibrillation; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Humans; Pulmonary Veins
PubMed: 35863815
DOI: 10.1016/j.jacep.2022.06.006 -
Journal of the American College of... Mar 2007Pulmonary vein pathologies often present a diagnostic challenge. Among the different imaging modalities used for the evaluation of pulmonary veins, magnetic resonance is... (Review)
Review
Pulmonary vein pathologies often present a diagnostic challenge. Among the different imaging modalities used for the evaluation of pulmonary veins, magnetic resonance is the most comprehensive in assessing anatomy and pathophysiology at the same time. Bright blood cine sequences and contrast-enhanced magnetic resonance angiography outline the course and connections of the pulmonary veins. Phase-contrast velocity mapping measures flow patterns, velocities, and volumes throughout the pulmonary circulation. This paper reviews contemporary utilization of magnetic resonance in the evaluation of pulmonary venous abnormalities in children, based on our experience over the last 5 years and on that of other investigators. We summarize how magnetic resonance imaging enhances our understanding of pulmonary vein physiology and how it can influence the diagnostic approach to children and adults with a pulmonary venous pathology, and we discuss its limitations.
Topics: Blood Flow Velocity; Cardiovascular Abnormalities; Catheter Ablation; Child; Child, Preschool; Constriction, Pathologic; Female; Humans; Infant; Magnetic Resonance Angiography; Male; Oximetry; Pulmonary Circulation; Pulmonary Veins
PubMed: 17336724
DOI: 10.1016/j.jacc.2006.09.052 -
Pulmonology 2021Pulmonary vein stenosis (PVS) is a rare condition, often difficult to diagnose and associated with poor prognosis at advanced stages. Lung parenchymal abnormalities are... (Review)
Review
Pulmonary vein stenosis (PVS) is a rare condition, often difficult to diagnose and associated with poor prognosis at advanced stages. Lung parenchymal abnormalities are indirect evidence of PVS and can manifest as multifocal opacities, nodular lesions, unilateral effusions, and interstitial septal thickening. These can lead to erroneous diagnoses of airway disease, pneumonia, malignancies or interstitial lung disease. This review summarizes the current literature about the approach to, evaluation and management of these patients. Our case report demonstrates that PVS is an under-recognized complication of cardiovascular surgery and should be considered in all patients presenting with respiratory symptoms after a cardiac procedure.
Topics: Female; Humans; Lung; Lung Diseases, Interstitial; Magnetic Resonance Imaging; Middle Aged; Phlebography; Pulmonary Veins; Stenosis, Pulmonary Vein
PubMed: 32571674
DOI: 10.1016/j.pulmoe.2020.05.010 -
Circulation. Arrhythmia and... Sep 2020Pulmonary vein (PV) stenosis is a highly morbid condition that can result after catheter ablation for PV isolation. We hypothesized that pulsed field ablation (PFA)... (Comparative Study)
Comparative Study
BACKGROUND
Pulmonary vein (PV) stenosis is a highly morbid condition that can result after catheter ablation for PV isolation. We hypothesized that pulsed field ablation (PFA) would reduce PV stenosis risk and collateral injury compared with irrigated radiofrequency ablation (IRF).
METHODS
IRF and PFA deliveries were randomized in 8 dogs with 2 superior PVs ablated using one technology and 2 inferior PVs ablated using the other technology. IRF energy (25-30 W) or PFA was delivered (16 pulse trains) at each PV in a proximal and in a distal site. Contrast computed tomography scans were collected at 0, 2, 4, 8, and 12-week (termination) time points to monitor PV cross-sectional area at each PV ablation site.
RESULTS
Maximum average change in normalized cross-sectional area at 4-weeks was -46.1±45.1% post-IRF compared with -5.5±20.5% for PFA (≤0.001). PFA-treated targets showed significantly fewer vessel restrictions compared with IRF (≤0.023). Necropsy showed expansive PFA lesions without stenosis in the proximal PV sites, compared with more confined and often incomplete lesions after IRF. At the distal PV sites, only IRF ablations were grossly identified based on focal fibrosis. Mild chronic parenchymal hemorrhage was noted in 3 left superior PV lobes after IRF. Damage to vagus nerves as well as evidence of esophagus dilation occurred at sites associated with IRF. In contrast, no lung, vagal nerve, or esophageal injury was observed at PFA sites.
CONCLUSIONS
PFA significantly reduced risk of PV stenosis compared with IRF postprocedure in a canine model. IRF also caused vagus nerve, esophageal, and lung injury while PFA did not.
Topics: Animals; Catheter Ablation; Dogs; Esophagus; Female; Lung Injury; Male; Models, Animal; Pulmonary Veins; Pulsed Radiofrequency Treatment; Stenosis, Pulmonary Vein; Therapeutic Irrigation; Time Factors; Vagus Nerve Injuries
PubMed: 32877256
DOI: 10.1161/CIRCEP.120.008337 -
Nihon Hoshasen Gijutsu Gakkai Zasshi 2019The aim of this study was to compare the image quality and the visibility of trigger angiography non-contrast enhanced (TRANCE) in diastolic phase and 3D balanced...
OBJECTIVE
The aim of this study was to compare the image quality and the visibility of trigger angiography non-contrast enhanced (TRANCE) in diastolic phase and 3D balanced steady-state free precession (3D SSFP) sequences for the evaluation of pulmonary vein (PV) and left atrium (LA).
METHODS
About 10 volunteers underwent TRANCE and 3D SSFP imaging on 1.5 T MRI. Axial images were reconstructed and regions of interest were positioned on the right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), LA, and left atrial appendage (LAA). Contrast-to-noise ratio (CNR) between each part and muscle were calculated and compared between two sequences. The two observers independently scored the image quality of each image on the basis of PV, LA, and LAA anatomy and contour using a five-point scale, which scores were averaged and compared.
RESULTS
CNRs on RSPV, RIPV, LSPV, LIPV, LA, and LAA were significantly higher in TRANCE sequence compared with 3D SSFP sequence. On visual assessment, TRANCE showed significantly higher scores in RSPV, RIPV, LSPV, LIPV compared with 3D SSFP sequence.
CONCLUSIONS
TRANCE provides higher image quality in PVs and LA compared with 3D SSFP on 1.5 T MRI. On visual assessment, TRANCE provides better visibility of PVs anatomy and contour compared with 3D SSFP.
Topics: Angiography; Heart Atria; Humans; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Pulmonary Veins
PubMed: 31105094
DOI: 10.6009/jjrt.2019_JSRT_75.5.454