After radiofrequency ablation for atrial fibrillation, patients may develop pulmonary vein stenoses requiring stent angioplasty. The treatment options for when such patients develop in-stent stenoses are poorly defined. The investigators retrospectively reviewed their initial experience with cutting balloon angioplasty for pulmonary vein in-stent stenosis. Ten patients with 21 previously stented pulmonary veins returned to the catheterization laboratory for in-stent stenoses. Angioplasty of individual in-stent stenotic vessels were grouped into standard angioplasty alone (n = 6) and a combination of cutting balloon followed by standard angioplasty (n = 15). Although final mean lesion diameter was increased significantly in the 2 groups, restenosis occurred in 4 of 6 vessels in the group with angioplasty alone and 2 of 15 vessels in the cutting balloon group. In conclusion, cutting balloon angioplasty for pulmonary vein in-stent stenosis appears to improve the intermediate results of repeat angioplasty.