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EP News: Heart Rhythm Case Reports

  • T. Jared Bunch
    Correspondence
    Address reprint requests and correspondence: Dr T. Jared Bunch, Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Eccles Outpatient Care Center, 5169 Cottonwood St, Suite 510, Murray, UT 84107.
    Affiliations
    Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
    Department of Internal Medicine, Stanford University, Palo Alto, California
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      Cryothermal balloon isolation of the pulmonary veins (PVs) is an established therapy for symptomatic drug-refractory atrial fibrillation (AF). Second-generation devices have improved the efficacy of energy delivery and success rates. More efficient energy delivery can increase collateral injury risk to the phrenic nerve, esophagus, and PVs. Watanabe et al (2017; doi: http://dx.doi.org/10.1016/j.hrcr.2017.05.010) presented a case of a 63-year-old man who underwent catheter ablation for AF using a 28-mm second-generation cryoballoon. Five months after the ablation procedure, the patient presented with recurrent hemoptysis. Bronchofibroscopy showed clot in the left lower trachea and recent bleeding with coughing at segment 4–5 of the left lung. Hemoptysis was significant enough to cause hypoxia and a decrease of 2 mg/dL in the hemoglobin level. The patient ultimately required removal of the left lingular segment of the lung, and necropsy showed complete occlusion of the PV. The patient’s hemoptysis improved, but mild dyspnea persisted. This case highlights the risk of untoward injury of adjacent tissues to the PVs with all energy sources as device efficacy increases and the need to consider PV stenosis upfront in patients with hemoptysis after AF ablation.
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