title: Drug-eluting stents for the treatment of pulmonary vein stenosis after atrial fibrillation ablation.
abstract: OBJECTIVE
  Pulmonary vein (PV) stenosis (PVS) is a complication of radiofrequency PV isolation (PVI). Reported restenosis rates after balloon dilatation and bare-metal stent implantation are high. Drug-eluting stent implantation (DES) has not been reported in the setting of PVS.
  
  
  RESULTS
  Patients suspected of having PVS after PVI based on clinical symptoms and transesophageal echocardiography (TEE) follow-up (FU) were referred for PV DES. One or more branches of the affected PV as documented by angiography were stented (paclitaxel or zotarolimus DES). Follow-up consisted of repeat PV angiography and TEE. Over a period of 2 years, five patients were treated with a total of eight DES. A paclitaxel DES was used in seven of eight implants. Mean FU was 12 ± 14 months during which all patients remained asymptomatic. Transesophageal echocardiography Doppler maximal flow velocity (V(max)) of the affected PVs rose from 58 ± 6 cm/s pre-PVI to 207 ± 20 cm/s pre-DES (+358%, P < 0.0001). After DES, V(max) decreased acutely with 86 ± 15 cm/s (-58%, P < 0.01). During FU, V(max) remained stable in three patients and increased moderately in one. Angiography at 3 months confirmed absence of restenosis in the first three patients and moderate (40%) restenosis in one patient. In one patient, an increase of V(max) back to pre-DES values correlated with a 65% peri-stent stenosis, treated with a redo DES. In total, after seven primary DES only one (asymptomatic) proximal margin restenosis required re-stenting.
  
  
  CONCLUSIONS
  Initial experience with DES for PV stenosis suggests an excellent stent patency rate. Transesophageal echocardiography Doppler measurements provide a viable way of monitoring stent patency.
authors.affiliation: Arrhythmia Section, Cardiology Department, Asklepios Klinik St Georg, Hamburg, Germany. tom.de.potter@olvz-aalst.be
authors.forename: Tom J R
authors.initials: TJ
authors.lastname: De Potter
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Kyoung Ryul Julian
authors.initials: KR
authors.lastname: Chun
authors.forename: Carsten
authors.initials: C
authors.lastname: Schneider
authors.forename: Rainer
authors.initials: R
authors.lastname: Malisius
authors.forename: Dieter
authors.initials: D
authors.lastname: Nuyens
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D054855:Drug-Eluting Stents; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel; D011667:Pulmonary Veins / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D020123:Sirolimus / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*
chemical_list: C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus