Total pulmonary vein occlusion as a consequence of catheter ablation for atrial fibrillation mimicking primary lung disease.
BACKGROUND
Catheter ablation has recently been used for curative treatment of atrial fibrillation.


RESULTS
Three of 239 patients who underwent ablation close to the pulmonary vein (PV) ostia at our institute developed severe hemoptysis, dyspnea, and pneumonia as early as 1 week and as late as 6 months after the ablation. Because the patients were arrhythmia-free, the treating physician initially attributed the symptoms to new-onset pulmonary disease (e.g., bronchopulmonary neoplasm). After absent PV flow was confirmed by transesophageal echocardiography, transseptal contrast injection depicted a totally occluded PV in all three patients. Successful recanalization, even in chronically occluded Pvs, was performed in all patients. During follow-up, Doppler flow measurements by transesophageal echocardiography demonstrated restenosis in all primarily dilated PV, which led to stent implantation.


CONCLUSIONS
PV stenosis/occlusion after catheter ablation of atrial fibrillation occurs in a subset of patients. However, because in-stent restenosis occurred in two patients after 6 to 10 weeks, final interventional strategy for PV stenosis or occlusion remains unclear. To prevent future PV stenosis or occlusion, a decrease in target temperature and energy of radiofrequency current or the use of new energy sources (ultrasound, cryothermia, microwave) seems necessary.
Ernst
Sabine
S
Department of Cardiology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany. sernst1708@aol.com
Ouyang
Feifan
F
Goya
Masahiko
M
Löber
Felix
F
Schneider
Carsten
C
Hoffmann-Riem
Martin
M
Schwarz
Stefan
S
Hornig
Klaus
K
Müller
Klaus-Michael
KM
Antz
Matthias
M
Kaukel
Eckhard
E
Kugler
Christian
C
Kuck
Karl-Heinz
KH
D000792:Angiography; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D018880:Atrial Premature Complexes / Q000150:complications / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006801:Humans; D011183:Postoperative Complications / Q000473:pathology*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology* / Q000473:pathology; D015607:Stents