Pulmonary vein occlusion: An unanticipated complication of catheter ablation of atrial fibrillation using the anatomic circumferential approach

Favorable results of circumferential pulmonary vein (PV) ostial ablation guided by electroanatomic mapping (Carto) have fueled great enthusiasm for this technique. The lesion set for this ablation procedure as described by Pappone et al. 1,2 involves a figure of 8 lesions encompassing the 2 right and 2 left PV ostia with 2 additional linear lesions. Pulmonary vein stenosis/or occlusion has not previously been reported as a complication of this procedure. We describe PV occlusion after this procedure. Based on the occurrence of this previously unreported complication, we no longer create a figure ‘8’ lesion around the right superior and inferior PVs. We anticipate that this complication can be avoided by creating a circular lesion encompassing the 2 PV ostia, while avoiding the linear lesion between the 2 PV ostia.