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Ventilation-Perfusion Mismatch Resulting From Iatrogenic Pulmonary Vein Stenosis After Radiofrequency Ablation: A Case Report
Clinical Cardiology, 10/20/09

Wong KK et al. – A lobar ventilation–perfusion mismatch is reported in a patient with right superior pulmonary vein stenosis, developing after radiofrequency ablation for atrial fibrillation. Radionuclide lung perfusion tomography was performed to assist with clinical management. Serial planar lung scintigraphy demonstrated no improvement in the perfusion abnormality despite interventional stenting. Iatrogenic pulmonary vein stenosis may potentially mimic pulmonary embolic disease.

Exclusive Author Commentary
Ka Kit Wong, 10/20/09

This case shows that iatrogenic pulmonary vein stenosis which is a rare complication of radiofrequency ablation treatment for atrial fibrillation may cause a segmental mismatched ventilation perfusion defect on lung scintigraphy and that this defect may persist despite catheter-based treatment of the stenosis. At the time we encountered this case this finding had not been widely published. Subsequently there have been additional case reports and small case series which confirm this finding and we have summarised these articles in the discussion. We believe that pulmonary vein stenosis should be added to the list of causes of mismatched ventilation and perfusion, and awareness of this finding will prevent misdiagnosis of pulmonary embolism. Lung scintigraphy may provide unique functional information in patients with pulmonary vein stenosis after catheter ablation which could help guide management.

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