Pulmonary vein stenosis following catheter ablation for atrial fibrillation is an acquired condition resulting from endothelial and transmural injury induced by energy delivery at the pulmonary vein–left atrial junction or within the venous lumen. The ensuing reparative process may involve intimal hyperplasia, fibrosis, and progressive contraction of the vessel wall, ultimately leading to partial or complete luminal obstruction. The clinical impact of this process depends on the degree of stenosis, the number of veins involved, and the capacity for collateral venous drainage.

The reported incidence of pulmonary vein stenosis has varied considerably across studies, reflecting differences in ablation technique, operator experience, imaging surveillance, and diagnostic thresholds. Early experiences with focal or segmental ostial ablation were associated with relatively high rates of venous narrowing. Subsequent modification of ablation strategies, favouring antral isolation and avoidance of energy delivery within the pulmonary veins, has resulted in a marked reduction in incidence. Despite these improvements, pulmonary vein stenosis has not been completely eliminated and remains an important consideration in post-ablation follow-up.

From a diagnostic perspective, contrast-enhanced computed tomography and magnetic resonance imaging are currently regarded as the most reliable non-invasive modalities for assessment of the pulmonary veins. These techniques allow direct visualisation of venous calibre and patency, as well as evaluation of secondary pulmonary findings related to impaired venous drainage. Familiarity with normal pulmonary venous anatomy and its variants is essential to avoid misinterpretation, particularly in cases of unilateral or segmental disease.

This poster presents a retrospective case series of four patients diagnosed with pulmonary vein stenosis following catheter ablation for atrial fibrillation. All patients underwent contrast-enhanced chest computed tomography as part of their diagnostic evaluation. Image analysis included axial, multiplanar, maximum intensity projection, and three-dimensional volume-rendered reconstructions. Particular attention was paid to the degree and location of venous stenosis, contrast opacification patterns, and associated pulmonary parenchymal changes. Clinical information was reviewed to assess presenting symptoms and the interval between ablation and diagnosis.