Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study

Julia Vogler, Thomas Fink*, Christian Sohns, Philipp Sommer, Alexander Pott, Tillman Dahme, Laura Rottner, Vanessa Sciacca, Malte Maria Sieren, Fabian Jacob, Jörg Barkhausen, Makoto Sano, Charlotte Eitel, Andreas Metzner, Feifan Ouyang, Karl Heinz Kuck, Roland Richard Tilz, Christian Hendrik Heeger

*Corresponding author for this work
2 Citations (Scopus)


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.

Original languageEnglish
JournalJACC: Clinical Electrophysiology
Issue number7
Pages (from-to)773-782
Number of pages10
Publication statusPublished - 07.2020

Research Areas and Centers

  • Academic Focus: Biomedical Engineering

DFG Research Classification Scheme

  • 205-30 Radiology, Nuclear Medicine, Radiation Therapy and Radiobiology


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