title: Evaluation of pulmonary vein stenosis after pulmonary vein isolation using a novel circular mapping and ablation catheter (PVAC).
abstract: BACKGROUND
  Pulmonary vein stenosis (PVST) is a well-known complication of pulmonary vein isolation (PVI). Specific anatomically designed ablation catheters for antral PVI have not been evaluated with regard to the incidence of PVST. We investigated the incidence, severity, and characteristics of PVST after PVI with the Pulmonary Vein Ablation Catheter (PVAC) and phased radiofrequency technology.
  
  
  RESULTS
  A total of 100 patients (55 men) underwent PVI for atrial fibrillation using the PVAC. PVI was guided by selective angiography of each pulmonary vein (PV) in 70 (70%) patients and by reconstructed 3D atriography (ATG) in 30 (30%) patients. Gadolinium-enhanced MRI or multidetector CT was performed in all patients before treatment and 93±78 days after PVI. PVST was classified as follows: insignificant (<25%), mild (25%-50%), moderate (50%-75%), or severe (>75%). A total of 410 PVs were analyzed. Cardiac imaging demonstrated a detectable narrowing of the PV diameter in 23 (23%) patients and in 28 (7%) PVs. In detail, insignificant PVST was observed in 12 (2.9%) PVs, mild PVST in 15 (3.7%), and moderate PVST in 1 (0.2%). No instances of severe PVST were observed. The use of 3D-ATG was associated with a lower incidence of PVST (0.8% [95% CI, 0.0%-2.2%] versus 5.4% [95% CI, 2.7%-8.1%], P=0.027).
  
  
  CONCLUSIONS
  To our knowledge, this study is the first to report the incidence of PVST using the PVAC. In this regard, the PVAC seems to be safe if used in an experienced center. In addition, the use of 3D-ATG may decrease the risk of PVST.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, University Medical Center Regensburg, Regensburg, Germany. Christian.von-Bary@klinik.uni-regensburg.de
authors.forename: Christian
authors.initials: C
authors.lastname: von Bary
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
authors.forename: Christian
authors.initials: C
authors.lastname: Dornia
authors.forename: Christoph
authors.initials: C
authors.lastname: Eissnert
authors.forename: Claudia
authors.initials: C
authors.lastname: Fellner
authors.forename: Philipp
authors.initials: P
authors.lastname: Latzin
authors.forename: Sabine
authors.initials: S
authors.lastname: Fredersdorf
authors.forename: Stefan
authors.initials: S
authors.lastname: Stadler
authors.forename: Okka W
authors.initials: OW
authors.lastname: Hamer
mesh_terms: D000368:Aged; D000792:Angiography; D001281:Atrial Fibrillation / Q000601:surgery*; D057791:Cardiac Imaging Techniques / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*