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Updated: May 22, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Severe Hemoptysis Caused by Right Inferior Pulmonary Vein Perforation During Circular-Array Pulsed-Field Ablation
Junichi Kishaba1, Yuichiro Sagawa1, Kazuya Murata1
1Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan.
Background:
Pulsed-field ablation (PFA) has emerged as a novel energy source for pulmonary vein isolation in atrial fibrillation. Although generally safe, rare complications may occur during catheter manipulation in challenging pulmonary veins.
Case Summary:
A 71-year-old man underwent PFA with a circular-array catheter for paroxysmal atrial fibrillation. Echocardiography showed preserved left ventricular systolic function and a left atrial diameter of 39 mm. The right inferior pulmonary vein (RIPV) measured 15 mm at the ostium but bifurcated immediately, complicating catheter advancement. During circular-array catheter manipulation in RIPV, oxygen desaturation occurred, requiring endotracheal intubation. Hemoptysis developed, and bronchoscopy revealed bleeding from the right-lower-lobe bronchus, suggesting RIPV perforation. Idarucizumab and protamine were administered, and contrast-enhanced computed tomography confirmed extravasation. Bleeding resolved with supportive care, and the patient was discharged after 13 days.
Discussion:
This case highlights a rare but serious complication associated with challenging RIPV anatomy during PFA.
Take-Home Message:
Careful manipulation of a guidewire and a circular-array catheter is essential in narrow, branching pulmonary vein to prevent vascular injury.
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