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

Thomas Fink; Julia Vogler; Riccardo Proietti; Vanessa Sciacca; Christian-Hendrik Heeger; Laura Rottner; Tilman Maurer; Andreas Metzner; Shibu Mathew; Charlotte Eitel; Ingo Eitel; Christian Sohns; Makoto Sano; Bruno Reissmann; Andreas Rillig; Feifan Ouyang; Karl-Heinz Kuck; Roland Richard Tilz

doi:10.1002/joa3.12777

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

J Arrhythm. 2022 Sep 12;38(6):1009-1016. doi: 10.1002/joa3.12777. eCollection 2022 Dec.

Authors

Thomas Fink^{1

2

3

3}, Julia Vogler¹, Riccardo Proietti⁴, Vanessa Sciacca^{1

3}, Christian-Hendrik Heeger^{1

2}, Laura Rottner^{2

5}, Tilman Maurer², Andreas Metzner^{2

5}, Shibu Mathew^{2

6}, Charlotte Eitel¹, Ingo Eitel⁷, Christian Sohns^{2

3}, Makoto Sano¹, Bruno Reissmann^{2

5}, Andreas Rillig^{2

5}, Feifan Ouyang^{2

5}, Karl-Heinz Kuck^{1

2}, Roland Richard Tilz^{1

2}

Affiliations

¹ University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig-Holstein Lübeck Germany.
² Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany.
³ Clinic for Electrophysiology, Heart and Diabetes Center North Rhine-Westphalia Ruhr-University Bochum Bad Oeynhausen Germany.
⁴ Department of Cardiac, Thoracic, and Vascular Sciences University of Padua Padua Italy.
⁵ Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany.
⁶ Department of Cardiology University Hospital of Giessen Giessen Germany.
⁷ University Heart Centre Lübeck, Department of Cardiology, Angiology, and Intensive Care Medicine University Hospital Schleswig-Holstein Lübeck Germany.

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.

Keywords: anticoagulation; antiplatelet therapy; atrial fibrillation; pulmonary vein stenosis; restenosis; triple therapy.