Severe pulmonary vein stenosis presenting with infection-like pulmonary findings after radiofrequency ablation for atrial fibrillation: A case report.

We report a case of severe pulmonary vein stenosis(PVS) with complete pulmonary vein occlusion(PVO) after radiofrequency ablation for atrial fibrillation(AF). A 51-year-old man presented to the respiratory department with chest tightness, dyspnea, and chest pain. Early chest computed tomography (CT) revealed inflammatory changes in the left lung and bilateral pleural effusions, and the patient responded poorly to antibiotic therapy. He had undergone radiofrequency catheter ablation for AF 5 months prior. On admission, inflammatory markers were not significantly elevated, procalcitonin was negative, and bronchoalveolar lavage fluid (BALF) culture and metagenomic next-generation sequencing (mNGS) revealed no definitive pathogenic infection. Subsequent cardiac CTA showed non-visualization of the left inferior pulmonary vein and stenosis of the left superior pulmonary vein near the left atrium, leading to a diagnosis of post-ablation pulmonary vein occlusion and stenosis. The patient underwent pulmonary vein stenting at another hospital, with follow-up CTA demonstrating restored opacification distal to the stents without intraluminal filling defects. This case highlights the need for prompt evaluation of pulmonary vein patency when focal pulmonary infection-like changes, chest pain, or pleural effusion occur after atrial fibrillation ablation when infection is not confirmed.