Non-invasive management may be a valid strategy for highly symptomatic pulmonary vein occlusion after AF ablation when catheter intervention is not possible, avoiding the need for surgical lobectomy.
May support non-invasive management for select post-ablation pulmonary vein occlusion when intervention impossible; hypothesis-generating, needs prospective confirmation.
Pulmonary vein occlusion (PVO) after atrial fibrillation ablation is often highly symptomatic. In cases with a clear target, balloon angioplasty and stenting can be successful. In the absence of such a target, surgical lobectomy has been reported as a treatment option, but the natural history of physiological adaptation may outweigh the risks of invasive therapies and a non-invasive strategy is valid in these situations. We present a case of highly symptomatic PVO managed non-invasively, with complete symptom resolution and return to high-intensity exercise. Catheter intervention may not always be possible in the absence of a target vessel, and lobectomy may not be necessary to manage PVO.
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Bittinger et al. (2012) studied this question.
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