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Iatrogenic Pulmonary Vein Thrombosis associated with Radiofrequency Catheter Ablation
Tian Sun1, Chidinma Tiko-Okoye1, Jaafar Elnagar1, Stephanie Honig1, Lia Michos1, Michael Walker2.
1Lankenau Medical Center, Philadelphia, PA, USA, 2Mainline Health, Philadelphia, PA, USA.

OBJECTIVE: Review a case of iatrogenic pulmonary vein thrombosis (PVT) leading to venous infarction of the left lower lobe (LLL) requiring surgical intervention following radiofrequency catheter ablation (RFCA).
METHODS: A 49-year-old male underwent pulmonary vein isolation and RFCA for new-onset atrial fibrillation. One month after RFCA, he presented with fever, dysphagia, vomiting, and hemoptysis; workup revealed PVT of the inferior pulmonary vein of the LLL. Ultimately, progression to LLL venous infarction required surgical management.
RESULTS: Workup including CTA revealed occlusion of the left inferior pulmonary vein with patchy consolidation of the LLL and left atrial wall thickening. Given additional concern for atrioesophageal fistula, the patient was taken to the operating room for EGD and flexible bronchoscopy. No fistula was found but a moderate amount of endobronchial blood was encountered; concerning for parenchymal infarction. He underwent operative exploration via muscle-sparing left anterolateral thoracotomy. Upon entry, the LLL was noted to be severely engorged with venous congestion. Lobectomy was performed. Dissection of the esophagus then took place without evidence of fistulization. Postoperatively, the patient recovered expectantly.
CONCLUSIONS: RFCA remains a reasonable option for patients with atrial fibrillation with the goal of rhythm control. PVT following RFCA is a rare complication that can arise 1-3 months post-procedure. Although rare, it is crucial to consider PVT in the differential diagnosis during post-procedural workup. There is no clear consensus on the management of post-ablation PVT. Our case highlights a potentially life-threatening complication following an ablation procedure, managed successfully through surgical intervention.


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