Hemoptysis as a side effect of cryoballoon pulmonary vein isolation in atrial fibrillation: a retrospective case-control study

  • Kevin-Gerrit Bullert
  • Klaus-Jürgen Gutleben
  • Dieter Horstkotte
  • Thomas Fischbach
  • Jan Körfer
  • Britta Körber
  • Georg NölkerEmail author



Hemoptysis and pulmonary hemorrhage are rarely described as complications of cryoballoon ablation for pulmonary vein isolation (CB PVI). This study evaluated a large cohort to determine the frequency and risk factors for manifestation of these complications and assess the clinical relevance of hemoptysis after CB PVI.


Seven hundred fifteen consecutive patients (351 female) from a single-center database were evaluated to identify those who developed hemoptysis after CB PVI.


A total of 31 patients with hemoptysis (4.3%; 2 female, age 60.5 ± 11.5 years) were matched with a control group (n = 31). Hemoptysis developed within 72 h after CB PVI. Cases versus controls had significantly lower ablation temperatures in the right inferior pulmonary vein (PV) (− 56.2 ± 26.6 vs − 49.1 ± 13.2 °C; p = 0.004) and left inferior PV (− 56.4 ± 11.9 vs − 47.2 ± 7.6 °C; p = 0.001). A trend to lower temperatures not reaching the level of significance was also found for the superior PV. All other procedural parameters were not significantly different between cases and controls. Although pre-procedural hemoglobin levels were comparable, post-procedural hemoglobin was lower in cases versus controls (12.9 ± 1.6 vs 13.7 ± 1.5 g/dL; p < 0.05). Twenty-six patients presenting with hemoptysis underwent chest CT scan, which showed perivenous infiltration at either the right (n = 23) or left inferior PV (n = 2) or no infiltrate (n = 1). No negative long-term effects were reported after 3, 6, and 12 months’ follow-up.


Post-procedural hemoptysis after CB PVI is a relatively frequent finding and was associated with low freezing temperatures and pulmonary tissue infiltration predominantly located at the right inferior PV. Hemoptysis resolved without long-term sequelae.


Cryoballoon ablation Atrial fibrillation Hemoptysis Pulmonary hemorrhage Complications 


Compliance with ethical standards

The study was approved by the ethics committee of the Ruhr-Universität Bochum, Sitz Bad Oeynhausen.

Conflicts of interest

The authors declare that they have no conflicts of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic for Cardiology, Herz- und Diabeteszentrum NRWRuhr-Universität BochumBad OeynhausenGermany
  2. 2.Agaplesion ev. BathildiskrankenhausBad PyrmontGermany

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