Unusually Delayed Presentation of Pulmonary Vein Stenosis After Atrial Fibrillation Ablation

Severe pulmonary vein stenosis may occur following catheter ablation of atrial fibrillation. Symptoms usually appear within a few months. It is often misdiagnosed due to symptoms that mimic more frequent pathologies, and there is frequently a long delay between initial symptoms and diagnosis. A 50-year-old man presented with hemoptysis after having undergone catheter ablation for atrial fibrillation three and six years prior. Diagnosis of the cause was difficult and involved a number of exams and erroneous initial hypotheses. Pulmonary vein stenosis was ultimately confirmed by transesophageal echocardiography. Balloon angioplasty of the affected pulmonary vein was performed, with initial clinical improvement but later restenosis. The patient then underwent surgical reconstruction of the vein. The three-year interval between catheter ablation and his presentation with symptoms is unusually long. Clinicians should retain pulmonary vein stenosis in their differential diagnosis of hemoptysis in patients having undergone pulmonary vein isolation for atrial fibrillation, even beyond the first year after catheter ablation.