Pulmonary vein narrowing after visually guided laser balloon ablation: Occurrence and clinical correlates
Introduction There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation. Methods and Results Patients with paroxysmal atrial fibrillation treate...
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| Published in: | Journal of cardiovascular electrophysiology Vol. 31; no. 7; pp. 1597 - 1605 |
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| Abstract | Introduction
There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.
Methods and Results
Patients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast‐enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross‐sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate‐severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2‐4.8] vs 2.5 [1.9‐3.3] cm2, P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7‐2.9] vs 0 [0‐1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate‐severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3‐2.5] per 1 cm2 increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.
Conclusions
Baseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation. |
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| AbstractList | Introduction
There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.
Methods and Results
Patients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast‐enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross‐sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate‐severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2‐4.8] vs 2.5 [1.9‐3.3] cm2, P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7‐2.9] vs 0 [0‐1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate‐severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3‐2.5] per 1 cm2 increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.
Conclusions
Baseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation. IntroductionThere are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.Methods and ResultsPatients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast‐enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross‐sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate‐severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2‐4.8] vs 2.5 [1.9‐3.3] cm2, P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7‐2.9] vs 0 [0‐1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate‐severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3‐2.5] per 1 cm2 increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.ConclusionsBaseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation. There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.INTRODUCTIONThere are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation.Patients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast-enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross-sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate-severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2-4.8] vs 2.5 [1.9-3.3] cm2 , P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7-2.9] vs 0 [0-1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate-severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3-2.5] per 1 cm2 increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.METHODS AND RESULTSPatients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast-enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross-sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate-severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2-4.8] vs 2.5 [1.9-3.3] cm2 , P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7-2.9] vs 0 [0-1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate-severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3-2.5] per 1 cm2 increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis.Baseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation.CONCLUSIONSBaseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation. There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the frequency and predictors of PV narrowing after VGLB ablation. Patients with paroxysmal atrial fibrillation treated with VGLB were screened. Study participants underwent contrast-enhanced computed tomography (CT) scanning before and 6 months after the procedure. We defined 25% to 49%, 50% to 74%, and 75% to 100% reduction in PV cross-sectional area as mild, moderate, and severe narrowing, respectively. Of 146 PVs in 38 patients analyzed, severe narrowing developed in two right superior and one right inferior PV. Moderate or severe narrowing occurred in 40 veins (27% of all PVs, 50% of the right superior, 22% of the right inferior, 21% of the left superior, and 14% of the left inferior PV). In PVs with moderate-severe narrowing, the baseline orifice area was significantly larger (4.1 [interquartile range, 3.2-4.8] vs 2.5 [1.9-3.3] cm , P < .0001), the narrowest region of stenosis was significantly more distal into the vessel (1.9 [0.7-2.9] vs 0 [0-1.7] mm from the orifice, P = .0006) and the total amount of energy delivered per vein was significantly greater (5190 ± 970 vs 4626 ± 1573 J, P = .018) than in PVs with mild or no significant narrowing. The baseline orifice area independently predicted moderate-severe narrowing in multivariate analysis (odds ratio, 1.8 [1.3-2.5] per 1 cm increase, P = .0003). No patient exhibited any signs or symptoms of PV stenosis. Baseline PV orifice area, ablating distally inside the veins, and total amount of laser energy are associated with PV narrowing after VGLB ablation. |
| Author | Takahashi, Yoshihide Hayashi, Tatsuya Goya, Masahiko Takigawa, Masateru Sekigawa, Masahiro Yamaguchi, Junji Yamamoto, Tasuku Tao, Susumu Shirai, Yasuhiro Sasano, Tetsuo |
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| CitedBy_id | crossref_primary_10_1016_j_jjcc_2021_07_001 crossref_primary_10_1007_s10840_022_01396_6 crossref_primary_10_1080_17434440_2021_1990754 crossref_primary_10_1007_s12928_024_01033_1 |
| Cites_doi | 10.1056/NEJM199809033391003 10.1016/j.jacc.2012.11.064 10.1161/01.CIR.0000154541.58478.36 10.1016/j.jcin.2008.12.014 10.1016/j.jacep.2016.07.002 10.1093/eurheartj/ehw210 10.1161/CIRCEP.117.005767 10.1111/j.1540-8167.2005.40680.x 10.1161/CIRCULATIONAHA.116.021949 10.1161/CIRCEP.109.933283 10.1161/CIRCEP.116.004588 10.1016/j.jacc.2015.07.036 10.1161/CIRCULATIONAHA.108.840587 10.1093/europace/eus304 10.1016/j.jacc.2016.10.037 |
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| Keywords | pulmonary vein stenosis atrial fibrillation visually guided laser balloon |
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| Notes | Disclosure Yoshihide Takahashi and Masateru Takigawa have received endowments from Medtronic Japan, Boston Scientific, Japan Lifeline, and WIN international. Yoshihide Takahashi and Masahiko Goya have also received speaker fees from Biosense Webster and Japan Lifeline. Other authors: No disclosures. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
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| Snippet | Introduction
There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to... There are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to assess the... IntroductionThere are limited data focusing on pulmonary vein (PV) narrowing following ablation using a visually guided laser balloon (VGLB). We sought to... |
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| SubjectTerms | Ablation atrial fibrillation Balloon treatment Computed tomography Fibrillation Lasers Multivariate analysis pulmonary vein stenosis Stenosis Veins & arteries visually guided laser balloon |
| Title | Pulmonary vein narrowing after visually guided laser balloon ablation: Occurrence and clinical correlates |
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