Table 5.

Signs and symptoms following AF ablation

	Differential	Suggested evaluation
Signs and symptoms of complications within a month postablation
Back pain	Musculoskeletal, retroperitoneal hematoma	Physical exam, CT imaging
Chest pain	Pericarditis, pericardial effusion, coronary stenosis (ablation related), pulmonary vein stenosis, musculoskeletal (after cardioversion), worsening reflux	Physical exam, chest X-ray, ECG, echocardiogram, stress test, cardiac catheterization, chest CT
Cough	Infectious process, bronchial irritation (mechanical, cryoballoon), pulmonary vein stenosis	Physical exam, chest X-ray, chest CT
Dysphagia	Esophageal irritation (related to transesophageal echocardiography), atrioesophageal fistula	Physical exam, chest CT or MRI
Early satiety, nausea	Gastric denervation	Physical exam, gastric emptying study
Fever	Infectious process, pericarditis, atrioesophageal fistula	Physical exam, chest X-ray, chest CT, urinalysis, laboratory blood work
Fever, dysphagia, neurological symptoms	Atrial esophageal fistula	Physical exam, laboratory blood work, chest CT or MRI; avoid endoscopy with air insufflation
Groin pain at site of access	Pseudoaneurysm, AV fistula, hematoma	Ultrasound of the groin, laboratory blood work; consider CT scan if ultrasound negative
Headache	Migraine (related to anesthesia or transseptal access, hemorrhagic stroke), effect of general anesthetic	Physical exam, brain imaging (MRI)
Hypotension	Pericardial effusion/tamponade, bleeding, sepsis, persistent vagal reaction	Echocardiography, laboratory blood work
Hemoptysis	PV stenosis or occlusion, pneumonia	Chest X-ray, chest CT or MR scan, VQ scan
Neurological symptoms	Cerebral embolic event, atrial esophageal fistula	Physical exam, brain imaging, chest CT or MRI
Shortness of breath	Volume overload, pneumonia, pulmonary vein stenosis, phrenic nerve injury	Physical exam, chest X-ray, chest CT, laboratory blood work
Signs and symptoms of complications more than a month postablation
Fever, dysphagia, neurological symptoms	Atrial esophageal fistula	Physical exam, laboratory blood work, chest CT or MRI; avoid endoscopy with air insufflation
Persistent cough, atypical chest pain	Infectious process, pulmonary vein stenosis	Physical exam, laboratory blood work, chest X-ray, chest CT or MRI
Neurological symptoms	Cerebral embolic event, atrial esophageal fistula	Physical exam, brain imaging, chest CT or MRI
Hemoptysis	PV stenosis or occlusion, pneumonia	CT scan, VQ scan

AF, atrial fibrillation; ECG, electrocardiogram; CT, computed tomography; MRI, magnetic resonance imaging; VQ, ventilation-perfusion.