Ventilation/Perfusion Mismatch in Pulmonary Vein Stenosis Secondary to Atrial Fibrillation Ablation

Document Type : Case Series

Authors

1 Tokushima University Graduate School of Health Sciences, Tokushima City, Japan

2 Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Japan

3 Department of Radiology, Tokushima University Hospital, Tokushima City, Japan

4 Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima City, Japan

5 Advance Radiation Research, Education and Management Center, Tokushima University, Tokushima City, Japan

6 Department of Diagnostic Radiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Japan

7 Department of Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Japan

Abstract

We present two patients with a history of paroxysmal atrial fibrillation who developed pulmonary vein stenosis (PVS) following atrial fibrillation (AF) ablation. Case 1 involved a female patient in her 50s who was asymptomatic for pulmonary symptoms but was found to have a high degree of left superior PVS 15 months after AF ablation. This was demonstrated using contrast-enhanced computed tomography (CE-CT) and supported by findings of perfusion defects on ventilation-perfusion (V/Q) scan. Case 2 was a male patient in his 60s who developed progressive left superior PVS nine months after AF ablation, evidenced by serial CE-CT and V/Q scans.
PVS is a rare but well-known complication of pulmonary vein ablation for the treatment of AF that can lead to severe complications if left untreated. V/Q scans effectively assess the functional significance of PVS by detecting abnormal blood flow segments. Although a V/Q mismatch characterized by reduced perfusion defects is more commonly used in evaluating pulmonary embolism, PVS should not be disregarded as a differential diagnosis. Few studies emphasize the utility of V/Q scans in managing PVS  and highlight V/Q mismatch as a notable finding. This case report aimed to highlight their significance.

Keywords

Main Subjects

References

  1. Rostamian A, Narayan SM, Thomson L, Fishbein M, Siegel RJ. The incidence, diagnosis, and management of pulmonary vein stenosis as a complication of atrial fibrillation ablation. J Interv Card Electrophysiol.2014; 40(1):63-74.
  2. Prieto LR. The state of the art in pulmonary vein stenosis -diagnosis & treatment. J Atr Fibrillation. 2010; 2(4):228.
  3. Raeisi-Giglou P, Wazni OM, Saliba WI, Barakat A, Tarakji KG, Rickard J, et al. Outcomes and management of patients with severe pulmonary vein stenosis from prior atrial fibrillation ablation. Circulation: Arrhythmia and Electro-physiology. 2018; 11(5): e006001.
  4. Saad EB, Rossillo A, Saad CP, Martin DO, Bhargava M, Erciyes D, et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation. Circulation. 2003; 108(25):3102-7.
  5. Fender EA, Widmer RJ, Hodge DO, Packer DL, Holmes DR. Assessment and management of pulmonary vein occlusion after atrial fibrillation ablation. JACC: Cardiovascular Interventions. 2018; 11(16): 1633-9.
  6. Nanthakumar K, Mountz JM, Plumb VJ, Epstein AE, Kay GN. Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging. 2004; 126(2):645-51.
  7. Simard T, Sarma D, Miranda WR, Jain CC, Anderson JH, Collins JD, et al. Pathogenesis, evaluation, and management of pulmonary vein stenosis: JACC review topic of the week. Journal of the American College of Cardiology. 2023; 81(24): 2361-73.
  8. Mansour M, Gerstenfeld EP, Patel C, Natale A, Whang W, Cuoco FA, et al. Pulmonary vein narrowing after pulsed field versus thermal ablation. EP Europace. 2024; 26(2):euae038. 
  9. Lee JJ, Weinberg D, Anand R. Asymptomatic pulmonary vein stenosis: Hemodynamic adaptation and successful ablation. Case Rep Cardiol. 2016; 2016: 4979182.
  10. Kumar N, Aksoy I, Pison L, Timmermans C, Maessen J, Crijns H. Management of pulmonary vein stenosis following catheter ablation of atrial fibrillation. J Atr Fibrillation. 2014; 7(1): 1060.
  11. Pazos-López P. Pulmonary vein stenosis: Etiology, diagnosis and management. WJC. 2016; 8(1):81.
  12. Bajc M, Schümichen C, Grüning T, Lindqvist A, Le Roux PY, Alatri A, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging. 2019; 46(12): 2429-51.
  13. Yun D, Jung JI, Oh YS, Youn HJ. Hemodynamic change in pulmonary vein stenosis after radiofrequency ablation: Assessment with magnetic resonance angiography. Korean J Radiol. 2012; 13(6): 816-9.
  14. Holmes DR, Monahan KH, Packer D. Pulmonary vein stenosis complicating ablation for atrial fibrillation: Clinical spectrum and interventional considerations. JACC: Cardiovascular Interventions. 2009; 2(4):267-76.
  15. Shroff N, Choi W, Villanueva-Meyer J, Palacio DM, Bhargava P. Pulmonary vein occlusion: A delayed complication following radiofrequency ablation for atrial fibrillation. Radiol Case Rep. 2021; 16(12): 3666-71.
  16. Kind F, Goetz C, Meyer PT, Föll D, Russe MF, Ruf J. Pulmonary vein stenosis as a pitfall of ventilation/perfusion SPECT/CT for pulmonary embolism. Clin Nucl Med. 2021; 46(3): 238-9.
  17. Yamaguchi K, Wakatsuki T, Matsuura T, Matsumoto K, Kawabata Y, Kadota M, et al. Drug-coated balloon angioplasty for severe pulmonary vein stenosis resulting from cryoballoon ablation for atrial fibrillation. Journal of Cardiology Cases. 2022; 26(1): 35-8.
  18. Narechania S, Renapurkar R, Heresi GA. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review. Pulmonary Circulation. 2020; 10(1): 2045894019882620.
  19. Ostwani W, Arabi M. Alteration in pulmonary perfusion due to iatrogenic pulmonary vein stenosis: A mimicker of pulmonary embolism. Avicenna J Med. 2011; 1(2): 58–60.
  20. Mazurek A, Dziuk M, Witkowska-Patena E, Piszczek S, Gizewska A. The utility of hybrid SPECT/CT lung perfusion scintigraphy in pulmonary embolism diagnosis. Respiration. 2015; 90(5): 393-401.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 13, Issue 1
January 2025
Pages 62-69

Files

Share

How to cite

Statistics