Recurrent pneumonia post atrial fibrillation ablation: do not forget to look for pulmonary vein stenosis

A man in his 50s presented with persistent chest pain, haemoptysis, cough and dyspnoea 5 months after undergoing catheter ablation for atrial fibrillation (AF). Several chest CT scans suggested pneumonia. Despite adequate treatment for recurrent pneumonia, symptoms persisted. While reviewing the ini...

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Bibliographic Details
Published in:BMJ case reports 2022-12, Vol.15 (12), p.e250896
Main Authors: Mizuno, Aki, Mauler-Wittwer, Sarah, Muller, Hajo, Noble, Stephane
Format: Article
Language:English
Subjects:
Ablation
Angioplasty
Antibiotics
Atrial Fibrillation
Cardiac arrhythmia
Case reports
Case Reports: Reminder of important clinical lesson
Catheter Ablation - adverse effects
Catheters
Constriction, Pathologic - surgery
Humans
Male
Medical imaging
Pain
Pneumonia
Pneumonia - complications
Pulmonary Veins - diagnostic imaging
Pulmonary Veins - surgery
Stenosis, Pulmonary Vein - diagnostic imaging
Stenosis, Pulmonary Vein - etiology
Stenosis, Pulmonary Vein - surgery
Treatment Outcome
Veins & arteries
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Summary:A man in his 50s presented with persistent chest pain, haemoptysis, cough and dyspnoea 5 months after undergoing catheter ablation for atrial fibrillation (AF). Several chest CT scans suggested pneumonia. Despite adequate treatment for recurrent pneumonia, symptoms persisted. While reviewing the initial chest CT, a partial venous infarction of the left lower lobe associated with severe left inferior pulmonary vein stenosis (PVS) was diagnosed. Stenting of the left inferior pulmonary vein with a vascular bare metal stent was performed, guided by fluoroscopy and transoesophageal echocardiography. Dual antiplatelet therapy (aspirin/clopidogrel) was introduced for 3 months, followed by long-term aspirin monotherapy. The treatment resulted in relief of his symptoms and the resolution of pulmonary opacities on chest CT. Despite low frequency, AF ablation remains the most common cause of acquired PVS. As highlighted in this case, symptoms are not specific and include recurrent pulmonary infection with delayed management.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2022-250896