Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures

Chun, Julian; Perrotta, Laura; Bordignon, Stefano; Khalil, Jan; Dugo, Daniela; Konstantinou, Athanasios; Fürnkranz, Alexander; Schmidt, Boris

doi:10.1016/j.jacep.2016.07.002

Cited by 69 publications

(69 citation statements)

References 24 publications

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“…Currently, cryoenergy is one of the most common technology in the catheter ablation of AF and cryoablation is an established procedure for PVI, particularly with the development of the second generation CB. Potential advantages of the CB include catheter adherence to tissue during ablation; homogeneous, circumferential, and durable ablation lesion; less risk of tamponade . However, the feasibility and safety of CB ablation for non‐PV sites, that is, LAA, and relevant technical data are limited.…”

Section: Discussionmentioning

confidence: 99%

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Chen

Schmidt

Bordignon

et al. 2019

Cardiovasc electrophysiol

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Introduction: Pulmonary vein isolation (PVI) is the cornerstone ablation strategy for treatment of atrial fibrillation (AF). Ablation outside the PVs is sometimes needed particularly in persistent or longstanding AF. This study reported left atrial appendage isolation (LAAI) using cryoballoon (CB) focusing on technical data and short-term clinical follow-up.Methods and results: Patients with recurrent persistent AF after multiple AF procedures were enrolled. LAAI was performed using the second generation CB guided by compound motor action potential (CMAP) and 240 seconds plus bonus freeze (ICE-B) protocol. Ten patients were included, median age was 69.5 (56-73) years, CHA 2 DS 2 -VASc score was 3 (1.8-4), LA diameter was 44 (38.8-46.5) mm. All patients had a mean of three AF procedures before the LAAI procedure. All patients were under successful CMAP guidance. During the CB LAAI procedure, the median time to LAA isolation was 100 (76-270) seconds, minimal freeze temperature was −50 (−57 to −47)°C. A "pull-down (or pull-away)" CB maneuver was performed in all patients. Median fluoroscopic time was 4.8 (3.4-6.8) minutes and acute LAAI success rate was 100%. No phrenic nerve injury or other major complications were observed.At 6-week follow-up, remapping of the LAA showed durable isolation of all PVs (100%), all patients were scheduled for LAA occlusion. Six-month follow-up showed that 80% of patients were free from AF/AT recurrence. Conclusion: CMAP plus ICE-B guided LAAI using cryo-technology appears feasible and safe, results in durable LAAI, and shows promising clinical results in patients with recurrent persistent AF. K E Y W O R D S ablation, atrial fibrillation, cryoballoon, left atrial appendage, pulmonary vein isolation J Cardiovasc Electrophysiol. 2019;30:272-283. wileyonlinelibrary.com/journal/jce 272 |

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Section: Discussionmentioning

confidence: 99%

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Chen

Schmidt

Bordignon

et al. 2019

Cardiovasc electrophysiol

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“…The most frequent complications were phrenic nerve palsy or vascular access injury. Chun et al 39 reported a statistically lower risk of tamponade among the cryoballoon PVI group than among the RF PVI group. This may in part be related to the requirement for only a single transseptal puncture to be performed, compared with two punctures, for more instances of RF PVI.…”

Section: S T Mathew and S S Pomentioning

confidence: 98%

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

Mathew

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Careful patient selection and optimization of the management of active medical conditions prior to proceeding with catheter ablation for atrial fibrillation (AF) is critical to reducing complications and improving ablation success. AF ablation performed on patients who have not been offered appropriate antiarrhythmic drug therapy must be tempered with the procedure risks, particularly for those patients having multiple comorbidities. The inability to comply with systemic anticoagulation for thromboembolic prophylaxis in AF is a contraindication to AF ablation, as premature termination of anticoagulation therapy can lead to catastrophic thromboembolic complications. Successful pulmonary vein isolation (PVI), the cornerstone of AF ablation, is demonstrated by entrance and exit block post ablation, with sustained absence of atrium-to-pulmonary vein conduction in both directions. Beyond PVI, there is no consensus for other endpoints for AF ablation, particularly in patients with persistent or longstanding persistent AF. Complications of PVI for AF have decreased in recent years as technology and knowledge in this field has evolved; however, the risks of cardiac tamponade, thromboembolic complications, esophageal injury, and pulmonary vein stenosis may still be formidable.

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“…The complication rate did not significantly differ in the RF and CB groups (respectively, 3.6% vs 2.2%; p=0.1). Chun et al [15] . have recently published the differential risk of cardiac tamponade in AF ablation procedures undertaken from May 2010 to July 2015 at a single center.…”

Section: Single Center Studies Comparing the Safety Of Cb Ablation Vsmentioning

confidence: 99%

“…A study has compared the incidence of pericardial effusion in a total of 133 consecutive patients undergoing ablation for paroxysmal AF (87 by RFA vs. 46 patients by CB-A) and no significant difference in the incidence of pericardial effusion between the cryoballoon and the RF groups were detected (11 vs. 16%) [26] . However, the incidence of cardiac tamponade has been reported to be higher following RFA [15]. A longer procedural time, coronary artery disease and arterial hypertension were found to be independent predictors of pericardial effusion during AF ablation [26] .…”

Section: Pericardial Effusion and Tamponadementioning

confidence: 99%

Complications of Atrial Fibrillation Cryoablation

Canpolat

Koçyiğit

Aytemir

2017

Journal of Atrial Fibrillation

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Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.

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Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures

Abstract: The risk for CT in patients undergoing AF ablation at a single high-volume center was decreased with the use of balloon catheters. Extensive radiofrequency current ablation beyond PVI leads to an increased perforation risk.

Cited by 69 publications

References 24 publications

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

Complications of Atrial Fibrillation Cryoablation

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