Table 5.
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.