Pulmonary Vein Stenosis Following Ablation for Atrial Fibrillation

Pulmonary vein stenosis (PVS) is a rare but potentially serious complication of catheter ablation for atrial fibrillation (AF), often presenting with non-specific respiratory symptoms and initially misdiagnosed. Early recognition is crucial to reduce the risks of progressive pulmonary hypertension, infarction, and long-term morbidity. We report a 65-year-old woman who presented with progressive dyspnoea on exertion, marked reduced exercise tolerance, lethargy, chest pain , and new onset haemoptysis. These symptoms began five months following an ablation procedure for symptomatic AF. Initial evaluations by primary care and cardiology teams attributed symptoms to lower respiratory tract infection or drug toxicity. On admission to the hospital, vital signs were normal, and routine investigations were unremarkable. Cardiac CT with pulmonary venography confirmed high-grade ostial stenosis (> 90%) of both left pulmonary veins. The patient underwent elective percutaneous pulmonary venoplasty with stenting under general anaesthesia. Post-procedural follow-up showed marked improvement in symptoms and patency of the left pulmonary veins on imaging. PVS secondary to catheter ablation is a rare but important post-ablation complication, which is frequently misdiagnosed due to non-specific symptoms. High clinical suspicion, early imaging, and timely endovascular intervention are important to optimise outcomes and minimise restenosis risk. Clinicians should consider PVS in any patient presenting with progressive dyspnoea, haemoptysis , or chest pain in the months following atrial ablation. This case highlights the importance of awareness to enable early diagnosis and treatment, preventing potential morbidity.