0
Correspondence |

HemoptysisHemoptysis: Déjà Vu for Cryoballoon: Déjà Vu for Cryoballoon Use for Pulmonary Vein Isolation for Atrial Fibrillation Ablation FREE TO VIEW

Narendra Kumar, MD; Carl Timmermans, MD, PhD; Laurent Pison, MD, PhD; Harry Crijns, MD, PhD
Author and Funding Information

From the Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht.

Correspondence to: Narendra Kumar, MD, Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands; e-mail: drnarendra007kr@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1435. doi:10.1378/chest.14-0236
Text Size: A A A
Published online
To the Editor:

In a recent issue of CHEST (January 2014), Martí-Almor et al1 elegantly described a case report of pulmonary hemorrhage after cryoballoon ablation for atrial fibrillation. At Maastricht University Medical Centre, we also came across patients with similar presentations. There has been an upsurge in similar, but sporadic case reports other than the references provided by Martí-Almor et al.2,3 Weig et al4 observed coughing and hemoptysis for three of 83 patients for up to 1 week secondary to a CT scan-documented frozen lung complication. They also observed that hemoptysis was seen only among the patients whose minimum freezing temperature of cryoballoon was < −55°C. Vogt et al5 observed development of cough with reversible hemoptysis in five of 293 patients. In their study, CT scan of the lungs revealed hematomas and edema around a pulmonary vein due to freezing of lung tissue. Notably, the cryoballoons were used for two applications of 6 min per vein. Avitall et al6 electrically isolated pulmonary veins using cryoballoon ablation in dogs. However, within 24 to 48 h, hemoptysis developed in most of the animals due to freezing extension from the left atrium to the lungs. In an earlier animal study, after thoracotomy, Neel et al7 froze lung tissue with a freezing probe without penetrating the lung. After thawing, hemorrhagic infarctions were observed. The treating physicians need to be cautious about hemoptysis not only during cryoballoon ablation but also during patient follow-up.

References

Martí-Almor J, Jauregui-Abularach ME, Benito B, et al. Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation. Chest. 2014;145(1):156-157.
 
van Opstal JM, Timmermans C, Blaauw Y, Pison L. Bronchial erosion and hemoptysis after pulmonary vein isolation by cryoballoon ablation. Heart Rhythm. 2011;8(9):1459.
 
Conte G, Chierchia GB, Casado-Arroyo R, Ilsen B, Brugada P. Pulmonary vein intramural hematoma as a complication of cryoballoon ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24(7):830-831.
 
Weig HJ, Weretka S, Parade U, et al. Cryo-specific complications using the single big cryoballoon technique for pulmonary vein isolation in patients with paroxysmal atrial fibrillation [abstract]. Eur Heart J. 2010;31(suppl 1):556.
 
Vogt J, Heintze J, Noelker BG, et al. Side effects and success of antral isolation of pulmonary veins with cryoballoon technique in a large patient cohort with atrial fibrillation [abstract]. Eur Heart J. 2009;30(suppl 1):813.
 
Avitall B, Lafontaine D, Rozmus G, et al. The safety and efficacy of multiple consecutive cryo lesions in canine pulmonary veins-left atrial junction. Heart Rhythm. 2004;1(2):203-209.
 
Neel HB III, Farrell KH, Payne WS, DeSanto LW. Cryosurgery of respiratory structures. II. Cryonecrosis of the lung. Laryngoscope. 1974;84(3):417-426.
 

Figures

Tables

References

Martí-Almor J, Jauregui-Abularach ME, Benito B, et al. Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation. Chest. 2014;145(1):156-157.
 
van Opstal JM, Timmermans C, Blaauw Y, Pison L. Bronchial erosion and hemoptysis after pulmonary vein isolation by cryoballoon ablation. Heart Rhythm. 2011;8(9):1459.
 
Conte G, Chierchia GB, Casado-Arroyo R, Ilsen B, Brugada P. Pulmonary vein intramural hematoma as a complication of cryoballoon ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24(7):830-831.
 
Weig HJ, Weretka S, Parade U, et al. Cryo-specific complications using the single big cryoballoon technique for pulmonary vein isolation in patients with paroxysmal atrial fibrillation [abstract]. Eur Heart J. 2010;31(suppl 1):556.
 
Vogt J, Heintze J, Noelker BG, et al. Side effects and success of antral isolation of pulmonary veins with cryoballoon technique in a large patient cohort with atrial fibrillation [abstract]. Eur Heart J. 2009;30(suppl 1):813.
 
Avitall B, Lafontaine D, Rozmus G, et al. The safety and efficacy of multiple consecutive cryo lesions in canine pulmonary veins-left atrial junction. Heart Rhythm. 2004;1(2):203-209.
 
Neel HB III, Farrell KH, Payne WS, DeSanto LW. Cryosurgery of respiratory structures. II. Cryonecrosis of the lung. Laryngoscope. 1974;84(3):417-426.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543