Comprehensive Review of Pulmonary Hemoptysis After Cryoballoon Ablation of Atrial Fibrillation: A Serious Problem Needs Special Care

Abstract

To review the literature and published data for pulmonary hemorrhage and hemoptysis after cryo-balloon ablation of atrial fibrillation. PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched for published articles and case reports. Our review and search have no restrictions on regions but were limited to human case reports and case series and articles published in English language. We also manually reviewed the publications reference lists to identify other relevant studies. The data was set until first of March 2020 with total of 93 cases out of 2064 with hemoptysis after CBA. From 9 studies a total of 2051 patients with mean age of 57.9±4.3 years had CBA for AF. These studies reported 80 cases with hemoptysis with incidence of 3.9%. The mean follow-up duration ranged from 1 to 12 months. Published cases showed onset of hemoptysis within the first day (47.5%) up to 7 (47.5%) days after CBA. Only 5 cases with massive hemoptysis have been reported during the procedure and 80% of reported cases presented with mild hemoptysis. Mean number of applications for CBA was 2.3±0.9 and mean duration of application was 235.9±57.8 seconds. Recently a concern has been raised about pulmonary complications post CBA. The long-term sequelae of CBA to the lungs are, thus far, unexplored. This review highlights that hemoptysis post CBA is not uncommon and can be avoided by careful selection of patients with careful manipulation during isolation of LSPV and RIPV with optimized freezing temperature will decrease hemoptysis incidence in the near future. The Positive aspect is that most of patients present with mild form of hemoptysis but with the fact that this complication has delayed occurrence.