An uncommon but potentially serious complication of catheter ablation for atrial fibrillation (AF) is pulmonary vein stenosis. The patient may be asymptomatic or may develop symptoms weeks or months after the ablation procedure.


Occurrence: reported as 1-10% of procedures but can be higher depending on how it is defined and the adequacy of follow-up.


Risk factor for pulmonary vein stenosis:

(1) repeat ablation procedure to the pulmonary vein

(2) thrombosis

(3) intense or multi-focal treatment of pulmonary veins

(4) operator inexperience


Onset: from a few days to 7 months after the procedure


Clinical findings:

(1) dyspnea at rest

(2) dyspnea on exertion

(3) cough or "bronchitis"

(4) chest pain which may be pleuritic

(5) wheezing or "asthma"

(6) hemoptysis

(7) flu-like symptoms

(8) orthopnea


Symptoms are affected by the number of veins showing stenosis and the severity of the stenosis. The onset may be gradual so that continued followup after the procedure is necessary. Progression of the stenosis is unpredictable and may be rapid (Holmes et al).


Diagnosis can made by imaging studies (spiral CT scan, transesophageal echocardiography) to demonstrate narrow of the treated pulmonary vein. Some patients with significant stenosis can be asymptomatic so some clinicians perform a screening scan 3 months after the procedure.


Initial therapy for significant stenosis may involve balloon dilatation or stent placement but a third of patients may develop in-stent or in-segment restenosis requiring a repeated intervention which may include venoplasty.


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