Distal Left Main Bronchial Injury after Catheter Ablation for Atrial Fibrillation: Report of Two Cases

Aaron Sparks, Jonathan Kozinn, Alan Wimmer and James R Stewart

Departments of Surgery, University of Missouri-Kansas City School of Medicine, USA

^*Correspondance to: James R Stewart 

 PDF  Full Text DOI: 10.25107/2474-1647.1683

Abstract

We report two patients who developed respiratory complications after catheter ablation for atrial fibrillation seen recently at our institution. The first patient presented with worsening dyspnea. Outpatient bronchoscopy was performed and demonstrated a pin-point opening in the distal left main bronchus 6 months after RF and previous cryothermal ablation. The patient was managed with rigid bronchoscopy, left main bronchial dilatation and silicone stent placement. The second patient presented within 24 h of the procedure at an outside institution with severe prolonged episodes of cough and dyspnea, and acute respiratory failure. He had pneumopericardium in addition to his respiratory symptoms. Fiber optic bronchoscopy was performed and the pericardium was drained surgically. He was found to have a full thickness thermal injury with loss of bronchial integrity immediately before the left main bifurcation, along the anterior surface of the bronchus. He was supported with ventilation, serial bronchoscopic evaluations, hemodynamic and antibiotic support, and eventual tracheostomy. Both patients are improved after treatment. We believe these are the first two reported cases of this complication following radiofrequency catheter ablation. Since its introduction in the 1990’s, the indications for catheter ablation of the left atrium for atrial fibrillation have expanded. Certain potential major and minor complications have been recognized. Major complications include periprocedural death (0.15%), esophageal injury with leak, aortoesophageal fistula (0.04%), cerebral thromboembolic events, TIA and stroke, (0.94%), cardiac perforation with hemorrhage and tamponade (1.31%), pulmonary venous stenosis (0.29%), phrenic nerve injury (0.48%), and arrhythmias. Minor complications have included femoral false aneurysms or thrombosis (0.93%) and arteriovenous fistulas (0.54%). We present two patients with injury to the distal left main bronchus as a consequence of RF and cryoballoon ablation. The first patient presented 6 months after the RFA. He developed progressive dyspnea with minimal exertion. The second patient presented within 24 h of the RFA with severe coughing paroxysms, dyspnea, and respiratory failure. We describe the management of these patients.

Keywords

Atrial fibrillation; Bronchial injury and stenosis; Bronchial stent; Catheter ablation

Cite the article

Sparks A, Kozinn J, Wimmer A, Stewart JR. Distal Left Main Bronchial Injury after Catheter Ablation for Atrial Fibrillation: Report of Two Cases. Clin Surg. 2017; 2: 1683.