Ab-452642-4 pulmonary vein stenosis after catheter ablation of atrial fibrillation using a cryoballoon, hotballoon, or laser balloon

Severe pulmonary vein (PV) stenosis after PV isolation for atrial fibrillation (AF) is a severe complication that requires angioplasty. However, there have been no studies to compare the incidence of PV stenosis among several balloon-type ablations. This study aimed to compare the reduction of the PV cross-sectional area and the incidence of PV stenosis after cryoballoon (CB)-PVI, hot balloon-PVI (HB), or laser balloon (LB)-PVI. A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in two hospitals were included. They underwent contrast-enhanced multidetector computed tomography before and three months after the procedure. In all 4 PVs, the reduction of PV cross-sectional area was more significant in the LB group than in the CB or HB groups, respectively. (Figure A) Moderate-severe(>50%) and severe(>75%) PV stenosis was observed in 5.1% and 0.5% of the PVs, respectively. The incidence of moderate-severe PV stenosis was higher in the LB group than in the CB or HB groups (8.7%, 4.5%, and 6.1% in the LB, CB, and HB groups, respectively; P=0.03, Figure B). On the other hand, the incidence of severe PV stenosis was similar among the three groups (0.3%, 0.5%, and 1.0% in the LB, CB, and HB groups, respectively; P=0.46). Symptomatic PV stenosis requiring intervention occurred in one patient after HB-PVI. The total HB application time, greater LB power, and the use of a 3rd-generation LB were associated with the incidence of moderate-severe PV stenosis. While the reduction of PV cross-sectional area after LB-PVI was more significant than after CB-PVI or HB-PVI, the incidence of severe PV stenosis was similar among the three groups. Excessive application time and output were associated with the incidence of moderate-severe PV stenosis.