Bronchial Injury Post-Cryoablation for Atrial Fibrillation

Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury

“…Upon thawing, the investigators found evidence of hemorrhagic pulmonary infarction. Though some have described findings suggestive of this in patients with hemoptysis following Cryo‐PV, this entity has been excluded in several other reports using computed tomographic arteriography . Similarly, the current study's findings would refute the possibility of pulmonary infarction as we found no gross or histopathologic evidence of this phenomenon in any of the subjects.…”

“…Though vascular rupture through instrumentation could manifest within the observed timeline, such a phenomenon should be independent of variables such as nadir Temp Cryoballoon or CBA duration. Furthermore, this is inconsistent with other published reports that frequently point to a timeline ranging in hours to days following Cryo‐PV . Another proposed mechanism has to do with pulmonary capillary bed injury.…”

“…Consistent with our findings, their analysis revealed that colder Temp Cryoballoon (−65 ± 7 °C vs. −57 ± 21 °C) and deeper balloon positioning of a smaller cryoballoon into the PV ostia was associated with this observation. Likewise, similar outcomes were reported by Desai et al ., who discovered erosion of the anterior mucosa of the left main stem bronchus in close proximity to the left PVs. Hence, it appears that localized bronchial injury and/or erosion may result from ultra‐cold temperatures attained during Cryo‐PV through direct energy transfer.…”

“…One of the proposed mechanisms for cough and hemoptysis following AF ablation is that of PV stenosis. However, clinical reports of hemoptysis following Cryo‐PVhave consistently excluded this clinical entity . Moreover, typical cases of hemoptysis manifest within hours to days, further rendering PV stenosis unlikely.…”

“…Although Cryo‐PV is overall regarded as a safe ablation strategy, it can still pose a significant threat to the adjacent structures such as the esophagus, phrenic and vagus nerves, and even the bronchi . To date, there have been several published reports on unexplained pulmonary symptoms in patients who undergo Cryo‐PV raising concerns surrounding possible lung injury . In fact, as many as 1 in 6 patients can develop a persistent dry cough following Cryo‐PV, and rare cases of hemoptysis have also been reported .…”