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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Publication history
Published online: July 21, 2017
