Bronchial Injury - Yet Another Collateral Damage of Cryoablation

With the aging population, the burden of atrial fibrillation is increasing. Cryoablation is a novel technique for pulmonary vein isolation and is considered equally effective as radiofrequency ablation. Some of the known complications of cryoablation include phrenic nerve damage, esophageal injury, pulmonary vein stenosis, new onset atrial flutter, pericardial effusion, and stroke. We present a case of bronchial injury immediately after cryoablation for symptomatic paroxysmal atrial fibrillation. A 67-year-old woman underwent successful pulmonary vein isolation using cryoablation. Her post-operative period was complicated with cough and hemoptysis. During the procedure, she had an extra 3 minutes of freezing of the left inferior pulmonary vein. Her bronchoscopy examination showed blood and erythema in the left main bronchus. She was managed conservatively with cough suppressants and anticoagulation was stopped. Possible etiology of bronchial injury is likely cryoenergy transfer between the pulmonary veins and the bronchus due to their close anatomic proximity. With the increasing use of cryoablation for atrial fibrillation, more cases of bronchial injury will likely be reported in the future. Physicians including electrophysiologist and pulmonologists should be aware of this complication.