Author + information
- Received November 25, 2019
- Revision received February 3, 2020
- Accepted February 4, 2020
- Published online May 12, 2020.
- Julia Vogler, MDa,∗,
- Thomas Fink, MDa,b,∗∗ (, )
- Christian Sohns, MDc,
- Philipp Sommer, MDc,
- Alexander Pott, MDd,
- Tillman Dahme, MDd,
- Laura Rottner, MDb,
- Vanessa Sciacca, MDa,b,
- Malte Maria Sieren, MDe,
- Fabian Jacob, MDe,
- Jörg Barkhausen, MDe,
- Makoto Sano, MD, PhDa,
- Charlotte Eitel, MDa,f,
- Andreas Metzner, MDb,
- Feifan Ouyang, MDb,g,
- Karl-Heinz Kuck, MDa,b,f,
- Roland Richard Tilz, MDa,b,f,† and
- Christian-Hendrik Heeger, MDa,b,f,†
- aDepartment of Cardiology, Medical Clinic II, University Hospital Schleswig-Holstein, Lübeck, Germany
- bDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- cDepartment of Electrophysiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
- dDepartment of Medicine II, Ulm University Medical Center, Ulm, Germany
- eDepartment of Radiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- fGerman Center for Cardiovascular Research (DZHK), Lübeck, Germany
- gDepartment of Cardiology, Fuwai Hospital/National Center of Cardiovascular Diseases, Beijing, China
- ↵∗Address for correspondence:
Dr. Thomas Fink, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Objectives This study sought to assess the incidence, procedural characteristics, contributing factors, and clinical outcome of cryoballoon-based pulmonary vein isolation (CB-PVI)–related hemoptysis in a multicenter study.
Background Hemoptysis has been described as a rare complication of CB-PVI. However, the precise mechanism and the etiology of this complication are poorly characterized.
Methods Consecutive patients undergoing CB-PVI for paroxysmal or persistent atrial fibrillation at 4 German hospitals were included in this observational analysis.
Results A total of 4,331 CB-PVI procedures were performed between 2006 and 2019. Fifteen patients (9 men, mean age 68.1 ± 9.8 years) developed acute hemoptysis during or within 24 h after CB-PVI, resulting in a hemoptysis frequency of 0.35%. Hemoptysis occurred in 6 of 720 procedures using the first-generation CB (0.83%) and in 9 of 3,611 procedures using the second-, third-, or fourth-generation CB (0.25%) (p = 0.015). Bronchoscopy was performed in 8 patients and showed bleeding exclusively due to mucosal injury or due to a coagulum at a bronchus adjacent to the ablation site. Hemoptysis resolved spontaneously without any long-term sequelae in all patients, except for a 92-year-old patient who died 13 days after CB-PVI due to pneumonia. No specific endobronchial treatment was necessary.
Conclusions Acute hemoptysis after CB-PVI is a rare but potentially life-threatening complication that is usually self-limiting. Direct thermal injury of bronchi adjacent to a pulmonary vein seems to be the most likely mechanism.
↵∗ Drs. Vogler and Fink contributed equally to this work and are joint first authors.
↵† Drs. Tilz and Heeger contributed equally to this work and are joint senior authors.
Dr. Sommer has received lecture fees from Medtronic. Drs. Eitel, Metzner, Kuck, Tilz, and Heeger have received travel or research grant support from Medtronic. Dr. Kuck has received consulting fees from Medtronic, Boston Scientific, Biosense Webster, Abbott, and Edwards Lifesciences. Dr. Tilz has received presentation fees from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 25, 2019.
- Revision received February 3, 2020.
- Accepted February 4, 2020.
- 2020 American College of Cardiology Foundation
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