Acute fatal pulmonary vein occlusion after catheter ablation of atrial fibrillation.
BACKGROUND
In treatment of atrial fibrillation (AF) catheter radiofrequency isolation of the pulmonary veins (PVs) has proved to be highly successful. There have been several case reports regarding PV stenosis, however none of these have reported a fatal outcome.


RESULTS
A 31-year-old man was referred to us for treatment of complications related to catheter ablation. According to the documentation from the hospital, the patient underwent segmental ostial PV isolation for treatment of AF. A few hours after the procedure, the patient developed dyspnoea, hemoptysis, and a high fever. The patient was first diagnosed as having pneumonia but five days later transesophageal echocardiography and pulmonal angiography revealed total occlusion of the left superior and inferior PVs. When we received the patient he underwent open-heart surgery, which showed thrombi in the orifices of the left sided PVs protruding into the left atrium. In each of the left sided PVs severe stenosis was seen in the bifurcation area. Thrombus material was removed followed by placement of two stents in each of the left sided pulmonary veins at the first bifurcations. However, the patient died 14 days after the ablation procedure. Selective autopsy of the left lung revealed diffuse alveolar damage, disseminated intravascular coagulation, multiple thrombi formation, and haemorrhagic infarctions.


CONCLUSIONS
PV stenosis may occur very early after the ablation procedure. Delayed diagnosis can be fatal. The early stenosis may result in thrombus formation in the left atrium and PVs and in this case surgery should be considered.
Nilsson
Brian
B
The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. rh12958@rh.dk
Chen
Xu
X
Pehrson
Steen
S
Jensen
Helle Lone
HL
Søndergaard
Lars
L
Helvind
Morten
M
Andersen
Lars Willy
LW
Svendsen
Jesper Hastrup
JH
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011667:Pulmonary Veins; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000209:etiology*; D015607:Stents; D014057:Tomography, X-Ray Computed