Pulmonary Vein Occlusion and Lung Infarction after Radiofreq
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A 33-year-old male presented with refractory AF, nine months postradiofrequency ablation. The patient developed symptomatic palpitations due to atrial fibrillation, and he was prescribed flecainide and bisoprolol. Despite the antiarrhythmic therapy, the patient continued to have significant symptomatic atrial fibrillation. Hence, the patient was taken for a second RFA.

During the RFA procedure, the left atrium and all four PVs were individually isolated and mapped using the CARTO-3 advanced 3D cardiac mapping system. It was noticed that the patient has left common pulmonary veins. Antral ablation lesions were done, electrical isolation was created on both superior veins, and complete pulmonary vein isolation was achieved and verified by pacing attempts and verification of exit block in both veins.

Two months later, the patient presented with cough associated with haemoptysis and mild left-sided pleuritic chest pain. He underwent computed tomography pulmonary angiogram (CTPA), which showed multiple patches of consolidation as well as ground glass opacities in the left upper lobe and lingula with minimal left pleural effusion. The patient was given broad spectrum antibiotics. Haemoptysis still persisted. Therefore, a contrast-enhanced CTPA was performed showing features of unilateral left pulmonary venous congestion, and the left superior and inferior pulmonary veins were not visualized both signifying occlusion, due to the prior ablation.

Findings of coronary CTA were consistent with the CTPA finding of left pulmonary vein occlusion. A lung perfusion study, showed absent perfusion in the left lung field in all perfusion views. In the ventilation images, there was adequate ventilation of the left lung, though it was lower compared to the right lung. A bronchoscopy was done as well and reported to be normal (no bleeding).

Based on the diagnosis of left pulmonary vein occlusion in CTPA, the patient underwent balloon angioplasty of the same. The procedure was complicated by arrhythmia and pericardial effusion which was drained successfully.

source: https://www.hindawi.com/journals/cripu/2020/2357846/