Haemoptysis as Complication of Wire-Guided Pulmonary Vein Orifice Cryoballoon Ablation in Complex Anatomy: a Clinical Case Series

Background . Cryoballoon ablation of pulmonary vein orifices is an effective measure in atrial fibrillation but associates with risks of interventional complications, including haemoptysis. The described clinical case series presents novel evidence to revisit the complication sources. Materials and methods . Four haemoptysis-complicated cryoballoon ablations of pulmonary vein orifice have been analysed retrospectively. Interventions completed in a common clinical protocol with no additional postoperative complications. Results . Fluoroscopy revealed a loop-formed balloon-supporting end of guidewire located in peripheral lower lobe of right lung. Postoperative chest computed tomography also depicted the main lung blood volume confined in right lower lobe, thus indicating pulmonary damage by the guidewire. Discussion . Pulmonary vein anatomy is diverse and can greatly sophisticate the cryoballoon ablation procedure with a peculiar balloon navigation in left atrium. An optimal pulmonary vein orifice occlusion can be attained with guidewire, albeit incurring complications in form of haemoptysis. Conclusions . The appliance advancement towards lung periphery associates with a higher risk of haemoptysis and bleeding. Perioperative haemoptysis and bleeding are most likely associated with mechanical injury to minor veins and require further investigation.