Bronchial effects of cryoballoon ablation for atrial fibrillation

Autonomic nervous system modulation and clinical outcome after pulmonary vein isolation using the second‐generation cryoballoon

“…A similar vagal reaction was observed during high‐frequency stimulation of the fat pads containing GPs because GP stimulation results in both sympathetic and parasympathetic activity, but parasympathetic reflexes are almost immediate . Interestingly, all the reactions were observed only after an LSPV ablation, and were completely inhibited by the preceding RSPV ablation presumably because the RSPV ablation impaired the efferent vagal neurons from the anterior right GP, which serves as the integration center to modulate sinus rhythm . Given these results, it seems to be most likely that the intraprocedural vagal reactions during the PVI were a marker of superior left GP stimulation, by a direct effect of the CB application or a pulmonary reflex due to bronchial freeze‐thaw events, rather than ANS modulation/denervation .…”

Lesion distribution after cryoballoon ablation and hotballoon ablation: Late‐gadolinium enhancement magnetic resonance imaging analysis

“…Recently, fatal atriobronchial fistulae formation have also been reported as complications after CBA. Ice formation was visualized in the left mainstem bronchus during the CBA of the LSPV, while it was not seen for the RSPV . We could clearly demonstrate that the lesion extended inside the PV after CBA especially at the posterior‐superior segment of the LPV, where the left mainstem bronchus was closely located and often in direct contact with the LSPV.…”

“…Ice formation was visualized in the left mainstem bronchus during the CBA of the LSPV, while it was not seen for the RSPV. 20 We could clearly demonstrate that the lesion extended inside the PV after CBA especially at the posterior-superior segment of the LPV, where the left mainstem bronchus was closely located and often in direct contact with the LSPV. To avoid this complication, it was attempted to locate the CB more proximally at the LSPV, and relatively counterclockwise rotation should be considered to reduce the balloon-tissue contact at the posterior-superior segment of the LPV.…”

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

“…Design improvements incorporated in the Arctic Front Advance (AFA; Medtronic, Inc) facilitated a more uniform cooling profile and enhanced energy transfer into the cardiac tissue . Initially, dosing conditions established for Arctic Front were transferred to AFA; however, the observed rates of adverse events and complications (eg, phrenic nerve injury, hemoptysis, and atrioesophageal fistula formation) with the AFA suggested that there was a deeper and/or faster cooling which potentially created a higher risk of collateral tissue damage when using historic dosing practices …”