Revisiting pulmonary vein stenosis after high-power short-duration radiofrequency ablation in patients with atrial fibrillation

Abstract

Abstract Background High-power short-duration atrial fibrillation catheter ablation (HPSD-AFCA) of pulmonary vein (PV) isolation reduces the procedure time without a difference in the efficacy as compared to conventional power AFCA (ConvP-AFCA). PV stenosis (PVS) after AFCA is a rare complication. Purpose We compared the frequency of symptomatic PVS as a long-term complication between the ConvP-AFCA and HPSD-AFCA groups. Methods We included 3,851 patients undergoing AFCA between 2009 and 2022 prospectively. We evaluated the characteristics of patients diagnosed with clinically symptomatic PVS, ascertained using computed tomography during the follow-up period. The risk of PVS was compared between the ConvP-AFCA and HPSD-AFCA groups using propensity overlap weighting. Results Symptomatic PVS was diagnosed in 14 (0.4%) patients at a mean of 342.9 days after the procedure. After overlap weighting, PVS was significantly more frequent in the HPSD-AFCA group (incidence: HPSD-AFCA, 0.8% vs. ConvP-AFCA, 0.2%; weighted hazard ratio [HR] 6.27, 95% confidence interval [CI] 2.15-18.28; P<0.001). In the multivariable Cox regression analyses, repeat AFCA procedures (HR 3.52, 95% CI 1.18-10.55; P=0.024) and paroxysmal AF (HR 8.29, 95% CI 1.08-63.82; P=0.042) were also independently associated with PVS after AFCA. Among the PVs of patients with PVS, stenotic PVs had shorter antral diameters and a smaller cross-sectional area than non-stenotic PVs on preprocedural computed tomographic evaluations. Conclusion HPSD-AFCA, compared to ConvP-AFCA, was associated with a 6-fold increased risk of symptomatic PVS. Caution is required, especially in patients with plans for a repeated AFCA, paroxysmal AF, or small PV antrum.