Pulmonary vein stenosis requiring angioplasty or surgical treatment following pulmonary vein isolation: case series

Pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) is a rare but severe complication. Its severity depends on the cause, number of stenosed veins, and symptoms. For symptomatic patients, angioplasty is the first choice, while surgery is not recommended due to its high invasiveness.

Patient 1: A 60-year-old male developed symptomatic left superior and inferior PVS after two procedures of PVI using radiofrequency energy. Eight-millimetre stent in left-superior and 7-mm stent in left-inferior PV were placed. Patient 2: A 64-year-old male underwent PVI using radiofrequency energy with a high-power short-duration setting. Although the patient was asymptomatic, CT revealed left-inferior PVS along with infiltrative shadow of the same area. Considering the risk of pulmonary infarction and with the patient’s informed consent, a 7-mm diameter stent was placed. Patient 3: A 56-year-old male underwent PVI with a 28-mm cryoballoon, followed by radiofrequency ablation for bilateral inferior PV reconductions. Subsequently, he developed severe left-inferior PVS, uncontrollable haemoptysis, and pulmonary infarction, necessitating lower lung-lobe resection.

Classical PVS often results from multiple radiofrequency ablations, as seen in Patients 1 and 3. High-power short-duration ablation, as a novel technique associated with specific risks, should also be acknowledged. While PVS treatment is typically for symptomatic cases, it may be justified in high-risk asymptomatic patients, as in Patient 2. Although not first-line, surgery should be considered in cases with refractory symptoms, as in Patient 3.