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

doi:10.1016/j.jacep.2020.02.003

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

7 Citations (Scopus)

Abstract

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 language	English
Journal	JACC: Clinical Electrophysiology
Volume	6
Issue number	7
Pages (from-to)	773-782
Number of pages	10
ISSN	2405-500X
DOIs	https://doi.org/10.1016/j.jacep.2020.02.003
Publication status	Published - 07.2020

Funding

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.

Research Areas and Centers

Academic Focus: Biomedical Engineering

DFG Research Classification Scheme

2.22-30 Radiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacep.2020.02.003

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Vogler, J., Fink, T., Sohns, C., Sommer, P., Pott, A., Dahme, T., Rottner, L., Sciacca, V., Sieren, M. M., Jacob, F., Barkhausen, J., Sano, M., Eitel, C., Metzner, A., Ouyang, F., Kuck, K. H., Tilz, R. R., & Heeger, C. H. (2020). Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study. JACC: Clinical Electrophysiology, 6(7), 773-782. https://doi.org/10.1016/j.jacep.2020.02.003

@article{2888a7aa99c447b790c3dd7e77f9e6e1,

title = "Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study",

abstract = "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.",

author = "Julia Vogler and Thomas Fink and Christian Sohns and Philipp Sommer and Alexander Pott and Tillman Dahme and Laura Rottner and Vanessa Sciacca and Sieren, \{Malte Maria\} and Fabian Jacob and J{\"o}rg Barkhausen and Makoto Sano and Charlotte Eitel and Andreas Metzner and Feifan Ouyang and Kuck, \{Karl Heinz\} and Tilz, \{Roland Richard\} and Heeger, \{Christian Hendrik\}",

note = "Funding Information: 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. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = jul,

doi = "10.1016/j.jacep.2020.02.003",

language = "English",

volume = "6",

pages = "773--782",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier Inc.",

number = "7",

}

Vogler, J, Fink, T, Sohns, C, Sommer, P, Pott, A, Dahme, T, Rottner, L, Sciacca, V, Sieren, MM , Jacob, F , Barkhausen, J, Sano, M, Eitel, C, Metzner, A, Ouyang, F, Kuck, KH, Tilz, RR & Heeger, CH 2020, 'Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study', JACC: Clinical Electrophysiology, vol. 6, no. 7, pp. 773-782. https://doi.org/10.1016/j.jacep.2020.02.003

TY - JOUR

T1 - Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study

AU - Vogler, Julia

AU - Fink, Thomas

AU - Sohns, Christian

AU - Sommer, Philipp

AU - Pott, Alexander

AU - Dahme, Tillman

AU - Rottner, Laura

AU - Sciacca, Vanessa

AU - Sieren, Malte Maria

AU - Jacob, Fabian

AU - Barkhausen, Jörg

AU - Sano, Makoto

AU - Eitel, Charlotte

AU - Metzner, Andreas

AU - Ouyang, Feifan

AU - Kuck, Karl Heinz

AU - Tilz, Roland Richard

AU - Heeger, Christian Hendrik

N1 - Funding Information: 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. Publisher Copyright: © 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/7

Y1 - 2020/7

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85083015608

UR - https://www.mendeley.com/catalogue/63ed5b6f-1de8-3785-87ae-2386f3e0d2f5/

U2 - 10.1016/j.jacep.2020.02.003

DO - 10.1016/j.jacep.2020.02.003

M3 - Journal articles

C2 - 32703558

AN - SCOPUS:85083015608

SN - 2405-500X

VL - 6

SP - 773

EP - 782

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 7

ER -

Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study

Abstract

Funding

Research Areas and Centers

DFG Research Classification Scheme

UN SDGs

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