Risk of Symptomatic Pulmonary Vein Stenosis After Atrial Fibrillation Ablation With High‐Power Short‐Duration Approach

Symptomatic pulmonary vein stenosis (sPVS) is a rare but severe complication of transcatheter atrial fibrillation (AF) ablation. High-power, short-duration (HPSD) and very HPSD (vHPSD) approaches for radiofrequency (RF) AF ablation have been shown to improve procedural efficiency, with effectiveness and a short-term safety profile comparable to conventional standard-power long-duration (SPLD) ablation. Findings from some previous reports suggest that HPSD may be a risk factor for the development of sPVS. The aim of this multicenter, observational analysis was to compare the incidence of sPVS after AF ablation with HPSD, vHPSD, and SPLD. Data from 436 consecutive patients (63.1 ± 9.5 years, 66.5% male, 70.9% with paroxysmal AF) undergoing RF AF ablation were reviewed: 64 were ablated with HPSD, 71 with vHPSD, and 301 with SPLD. The incidence of sPVS during follow-up was assessed. There were no significant differences in baseline characteristics between the three groups. During a median follow-up of 20 months, 9 cases of sPVS were identified: 7 (10.9%) in HPSD group, 1 (1.4%) in vHPSD group, and 1 (0.3%) in SPLD group (p < 0.001). The use of HPSD approach was an independent predictor of sPVS (hazard ratio, 20.226; 95% confidence interval, 20.49-164.59; p = 0.005) on multivariable analysis. Seven of 9 patients underwent percutaneous PVs angioplasty and stent implantation (3 veins in 4 patients, 2 veins in 2 patients, 1 vein in 1 patient). The results of this observational analysis suggest that RF AF ablation using HPSD approach may be associated with an increased risk of sPVS.