Pulmonary vein occlusion/stenosis after pulmonary vein ablation for atrial fibrillation.

In this issue of the Journal. Ernst et al.1 report three cases of total pulmonary vein (PV) occlusion in 239 patients who underwent an ablation procedure for atrial fibrillation (AF). Patients initially were evaluated by internists and pulmonologists and underwent extensive evaluation before the diagnosis was finally made. Despite treatment with thrombolytics, glycoprotein IIb/IIIa inhibitors and anticoagulation, angioplasty, and stenting, restenosis developed. Because imaging studies after a PV ablation procedure were not routinely performed in all patients, the true incidence of PV stenosis and occlusion could not be determined. PV stenosis may be one of the most serious complications after a PV ablation procedure, as treatment options are limited and restenosis may recur after interventional procedures. Depending on the PV ablation strategy used and whether or not routine imaging studies were performed, the prevalence of PV stenosis has been reported to vary from 0% to 8%.2,3