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stenosis is a well-recognized complication of AF ablation that results from thermal injury to the PVs, including the media, intima, adventitia, and PV musculature. Since first reported in 1998, numerous studies have sought to determine the incidence, cause, diagnostic strategy and treatment approach for PV stenosis.434,927,1142,1143,1144,1145 Although the precise pathophysiological mechanisms are still uncertain, a progressive neointimal proliferation and myocardial fibrosis resulting in endovascular contraction has been reported after extensive radiofrequency energy ablation (RFA) to canine PVs.1146 PV stenosis has been described for both point-by-point RF ablation as well as CBA.244,462,482,928,1146,1147 To the best of our knowledge, significant PV stenosis has not been reported with the laser balloon system.498,503 There are controversial data regarding any impact that RF power output has on the rate of PV stenosis.244,1147 The incidence of PV stenosis might be somewhat lower with CB AF ablation than with RFA.1148,1149 In experienced hands, however, PV stenosis has become an increasingly uncommon complication with either ablation technology.489 The highest risk for PV stenosis is associated with RFA close to the PV orifices and/or within the PVs, with a 5.6-fold higher incidence in comparison with antral ablation.1147 Ablation within the PVs should be avoided, but can occur due to shifts in the 3D electroana-tomic map, respiratory motion, poor catheter stability, and/or an inexperienced operator."}