Lobectomy for Pulmonary Vein Occlusion Secondary to Radiofrequency Ablation

Abstract

Pulmonary vein stenosis, a recognized complication of transcatheter radiofrequency ablation in the left atrium, is often asymptomatic. Significant stenosis is commonly treated with percutaneous balloon dilation with or without stenting. We encountered a case of complete pulmonary vein occlusion that caused lobar thrombosis, pleuritic pain, and persistent cough. Imaging studies revealed virtually no perfusion to the affected lobe. A lobectomy was performed, resolving the persistent cough and pain. Pulmonary vein occlusion should be suspected in patients who present with pulmonary symptoms after having undergone ablative procedures for atrial fibrillation. This condition may necessitate surgical intervention if interventions such as balloon dilation or stenting are not possible or are ineffective.

Evaluation of Pulmonary Vein Stenosis After Pulmonary Vein Isolation Using a Novel Circular Mapping and Ablation Catheter (PVAC)

“…2,3 Today, different ablation techniques have been established using a segmental and anatomic approach for PVI, [3][4][5][6] and all of these strategies may be complicated by the risk of causing pulmonary vein stenosis (PVST), [7][8][9][10][11] which can be life threatening and challenging to treat. [12][13][14][15] …”

The Anatomic Impact of Sequential, Additional, Ostial Radiofrequency Ablation Following Pulmonary Vein Cryo‐Isolation

“…PV stenosis is one of the most serious complications of ablation for AF. It can be diagnosed using CT, magnetic resonance angiography, and echocardiography 12–20 . The postablation stenosis rates reported in the literature vary from 0% to 30% and appear to depend on the operator's technique and level of experience.…”

“…It can be diagnosed using CT, magnetic resonance angiography, and echocardiography. [12][13][14][15][16][17][18][19][20] The postablation stenosis rates reported in the literature vary from 0% to 30% and appear to depend on the operator's technique and level of experience. Distal ablation inside the vein, the use of high power levels (over 35 watts), and vein size have been reported as predictors of stenosis.…”

“…Various techniques have been developed and radiofrequency (RF) radiation is now the most commonly used energy source for PV isolation. However, RF ablation is limited by several potential complications, 12 the most serious of which is still PV stenosis 12–20 . Cryothermal energy is an alternative source that has been developed to overcome some of the disadvantages of RF ablation (such as tissue disruption by excess heating and the generation of inhomogeneous lesions that could lead to PV stenosis) 21 .…”

“…However, RF ablation is limited by several potential complications, 12 the most serious of which is still PV stenosis. [12][13][14][15][16][17][18][19][20] Cryothermal energy is an alternative source that has been developed to overcome some of the disadvantages of RF ablation (such as tissue disruption by excess heating and the generation of inhomogeneous lesions that could lead to PV stenosis). 21 Novel cryoballoon technologies have enabled application of the energy source over a wide area and isolation of the PV antrum with short operating and fluoroscopy times.…”