ventilation/perfusion mismatch in pulmonary vein stenosis secondary to atrial fibrillation ablation

We present two patients with a history of paroxysmal atrial fibrillation who developed pulmonary vein stenosis (pvs) following atrial fibrillation (af) ablation. case 1 involved a female patient in her 50s who was asymptomatic for pulmonary symptoms but was found to have a high degree of left superior pvs 15 months after af ablation. this was demonstrated using contrast-enhanced computed tomography (ce-ct) and supported by findings of perfusion defects on ventilation-perfusion (v/q) scan. case 2 was a male patient in his 60s who developed progressive left superior pvs nine months after af ablation, evidenced by serial ce-ct and v/q scans.pvs is a rare but well-known complication of pulmonary vein ablation for the treatment of af that can lead to severe complications if left untreated. v/q scans effectively assess the functional significance of pvs by detecting abnormal blood flow segments. although a v/q mismatch characterized by reduced perfusion defects is more commonly used in evaluating pulmonary embolism, pvs should not be disregarded as a differential diagnosis. few studies emphasize the utility of v/q scans in managing pvs  and highlight v/q mismatch as a notable finding. this case report aimed to highlight their significance.