Partially reversible lung consolidation after revascularization of a total occlusion of both left pulmonary veins following ablation of atrial fibrillation: a case report

Abstract

Background The use of pulmonary vein radiofrequency ablation for atrial fibrillation treatment may be complicated by pulmonary vein stenosis or occlusion. A common curative treatment for symptomatic patients is a transcatheter intervention, including percutaneous transluminal balloon angioplasty and stent implantation. Stent implantation itself, however, can be complicated by in-stent stenosis. Case Summary A 26-year-old man presented with worsening exertional dyspnoea due to a total occlusion of both left pulmonary veins after the isolation of two pulmonary veins for atrial fibrillation. Chest computed tomography (CT) showed chest asymmetry and consolidation of the left lung. The patient was treated with balloon angioplasty and stent placement of both left pulmonary veins, resulting in improvement of symptoms, walking distance, and increase in lung space volume by 120 mL based on CT-based volumetry. Ten months later the patient experienced a recurrence of similar symptoms. A high grade in stent restenosis of the upper left pulmonary vein and moderate in stent restenosis of the lower pulmonary vein was diagnosed and was treated with angioplasty. The patient was discharged from the hospital in good clinical conditions 3 days after the intervention. Discussion Non-specific symptoms of pulmonary vein stenosis or occlusion, such as shortness of breath, fatigue, flu like symptoms, reduced physical performance and haemoptysis delay the diagnosis. If unusual symptoms appear abruptly after pulmonary vein isolation, a pulmonary vein stenosis should be considered. In this case, we describe for the first time a partially reversible consolidation of lung parenchyma following the revascularisation of both pulmonary veins.

Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation

“…Acquired pulmonary vein stenosis secondary to cardiac ablation is defined as the reduction in vein lumen diameter near the location of pulmonary vein ablation [Figure 3]. Grading of this stenosis, accomplished by dedicated cardiac non-invasive imaging, ranges from mild (less than 50% reduction in lumen diameter) to moderate, and severe (greater than 70% reduction in lumen diameter) [24] . Morbidity from this iatrogenic diagnosis can vary from minimal to severe symptom burdens, and though corrective procedures exist, success rates vary and repeat surgeries/percutaneous interventions may be necessary due to the dynamic resolution process [25] .…”