Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

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

Document Type : Case Series

Authors
Leah Anne Christine L Bollos 1
Ryosuke Kasai 2
Hideki Otsuka 2
Yoichi Otomi 3
Tomomi Matsuura 4
Tamaki Otani 5
Koji Yamaguchi 4
Takanori Bando 1
Yuya Ueki 1
Noritake Matsuda 1
Satoru Takashi 3
Shota Azane 3
Yamato Kunikane 3
Shoichiro Takao 6
Shusuke Yagi 4
Masataka Sata 4
Hitoshi Ikushima 7
Masafumi Harada 3
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
10.22038/aojnmb.2024.79650.1561
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
Ventilation/ Perfusion Scan
Ventilation/ Perfusion Mismatch
Pulmonary Vein Stenosis
Atrial Fibrillation
Pulmonary Vein Ablation
Subjects
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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 13, Issue 1
January 2025
Pages 62-69