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

• Published in: Asia Oceania journal of nuclear medicine & biology Vol. 13; no. 1; pp. 62 - 69
• Main Authors: Bollos, Leah Anne Christine L, Kasai, Ryosuke, Otsuka, Hideki, Otomi, Yoichi, Matsuura, Tomomi, Otani, Tamaki, Yamaguchi, Koji, Bando, Takanori, Ueki, Yuya, Matsuda, Noritake, Takashi, Satoru, Azane, Shota, Kunikane, Yamato, Takao, Shoichiro, Yagi, Shusuke, Sata, Masataka, Ikushima, Hitoshi, Harada, Masafumi
• Format: Journal Article
• Language: English
• Published: Iran Mashhad University of Medical Sciences 2025
• Subjects: Abbreviations; Ablation; Angioplasty; atrial fibrillation; Cardiac arrhythmia; Case Series; Computed tomography; Dyspnea; Echocardiography; Hemoptysis; Hypoplasia; Lungs; Magnetic resonance imaging; Medical imaging; Morphology; Patients; Perfusion; Pulmonary arteries; Pulmonary embolisms; pulmonary vein ablation; pulmonary vein stenosis; Scintigraphy; Stenosis; Tomography; Veins & arteries; Ventilation; ventilation/ perfusion mismatch; ventilation/ perfusion scan; Pulmonary Vein Ablation; Ventilation/ Perfusion Mismatch; Ventilation/ Perfusion Scan; Pulmonary Vein Stenosis; Atrial Fibrillation
• ISSN: 2322-5718; 2322-5726
• DOI: 10.22038/aojnmb.2024.79650.1561

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.