CHEST Guidelines-Hemoptysis-After-Cryoablation-for-Atrial-Fibrillat

Hemoptysis-After-Cryoablation-for-Atrial-Fibrillat

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The correspondence to the editor discusses the occurrence of hemoptysis following cryoablation for atrial fibrillation, questioning if it's truth or myth. Cryoballoon, a relatively new tool for pulmonary vein isolation, has advantages over radiofrequency catheter ablation but may lead to complications due to collateral damage, including phrenic nerve paralysis, gastroparesis, and esophageal lesions. Hemoptysis, or coughing up blood, after cryoballoon ablation hasn't been regularly documented, nor has its definitive cause been identified. The vascular injury occurs due to ice formation within blood vessels, causing tears and hemorrhages post-reperfusion, which may result in hemoptysis from lung tissue damage.<br /><br />Research from Maastricht University Medical Center retrospectively assesses hemoptysis in patients post-cryoablation, revealing it occurred in 2.1% of cases. In 6 out of 283 patients who underwent pulmonary vein isolation, procedures to identify hemoptysis included a chest radiograph, CT scan, and bronchoscopy with a 1-year follow-up. Observations included right-sided diaphragmatic paralysis and ground glass opacification in several patients, typically on the right inferior or superior pulmonary vein. Moreover, lower temperatures and deeper positioning of smaller cryoballoons were found among those with hemoptysis.<br /><br />Statistical analysis suggests that the lower temperature of the right inferior pulmonary vein and deeper balloon positioning during cryoablation may likely cause vascular injury, leading to hemoptysis. The study concludes that hemoptysis is a rare side effect associated with cryoballoon ablation. The correspondence provides significant details on procedural parameters, patient data, and temperature measurements, emphasizing the need for further studies to ascertain hemoptysis etiology post-cryoablation. The authors disclose no potential conflicts of interest in their research.

Keywords

hemoptysis

cryoablation

atrial fibrillation

cryoballoon

pulmonary vein isolation

vascular injury

phrenic nerve paralysis

esophageal lesions

Maastricht University

statistical analysis