Hemoptysis as a complication in cryoballoon ablation of atrial fibrillation

Objective To evaluate the clinical characteristics, pulmonary veins-left atrial anatomy and prognosis of hemoptysis in patients after cryoballoon ablation of atrial fibrillation(AF). Methods From December 2013 to June 2017, 602 patients with AF underwent cryoballoon ablation in Shenyang Northern Hospital. The complication of hemoptysis was analyzed after cryoballoon ablation. Results After cryoballoon ablation for AF, hemoptysis occurred in 10 of 602 (1.66%). Among them, there were 7 males and 3 females, aged from 47 to 72 years old. There were 7 patients with paroxysmal AF and 3 patient with persistent AF. None had lung and bronchus disease. New oral anticoagulation was admitted from 5 to 10 days before ablation and active clotting time (ACT) was 256-310 s. Hemoptysis occurred around 10 hours to the day after procedure. And cough happened in the six patients during procedure. Anticoagulation treatment was not changed in 8 patients and reduced the dose in 2 patients. Symptoms and hemoptysis disappeared gradually after 3-14 days. Computer tomography (CT) scan of lung was performed in 2 patients and there were no abnormal changes.Three dimensional pulmonary vein CT showed that right superior pulmonary vein was closed to the right brunch of bronchus in 6 patients and left inferior pulmonary vein was closed to left bronchus in 4 patients. The lowest temperatures in cryoablation in those veins were -60--57℃ (first generation cryoballoon), and -55--53℃ (second generation cryoballoon), respectively. Conclusion Hemoptysis after cryoballoon ablation of AF may be related to the damage of bronchus mucosa during cryoablation. Key words: Cryoballoon ablation; Atrial fibrillation; Hemoptysis; Complication