How to identify and treat patient with pulmonary vein stenosis post atrial fibrillation ablation

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Purpose of reviewThe diagnosis of pulmonary vein stenosis, following catheter ablation of atrial fibrillation, potentially carries significant morbidity for affected patients. It is important that physicians remain aware of the entity and have an understanding of how to treat such patients. There has been controversy in how to assess patients following atrial fibrillation ablation, and how to treat asymptomatic patients with pulmonary vein stenosis. This article reviews the recently published data.Recent findingsThe reported incidence of pulmonary vein stenosis is decreasing. Nonetheless, it may not be found if not sought, as even patients with severe pulmonary vein stenosis may be asymptomatic. Also, patients with symptoms may be misdiagnosed if pulmonary vein stenosis is not included in the differential diagnosis. Computed tomography (CT) and MRI have been shown to be the diagnostic modalities of choice. The treatment options for severe pulmonary vein stenosis and occlusion are primarily that of pulmonary vein angioplasty with or without stenting. Despite the observed rate of restenosis, patients derive benefit from pulmonary vein angioplasty.SummaryThe best imaging modalities to assess for pulmonary vein stenosis are CT and MRI. Early intervention in symptomatic patients with severe pulmonary vein stenosis is warranted; in asymptomatic patients, the data suggest that such patients will also derive benefit.

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