Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury

Aryana, Arash; Bowers, Mark R.; Hayatdavoudi, Sa Man; Zhang, Yanhong; Afify, Alaa M; Reddy, Vivek Y.; O’Neill, Padraig Gearoid

doi:10.1111/jce.12983

Cited by 27 publications

(18 citation statements)

References 19 publications

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“…However, the optimal freezing strategy is still under debate 3–7 . Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree) 8–10 . Conversely, insufficient times may be associated with greater recurrence 9 …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7] Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree). [8][9][10] Conversely, insufficient times may be associated with greater recurrence. 9 Late-gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) offers a promising tool for noninvasive characterization of atrial myocardial fibrosis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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Introduction Ablation with second‐generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri‐pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late‐gadolinium‐enhanced cardiac magnetic resonance (LGE‐CMR). Methods and Results Forty‐nine consecutive patients (196 PVs) undergoing ablation with second‐generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE‐CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (−45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. Conclusions After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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“…The mechanism of hemoptysis is supposed to be the bronchi injury. 11,15 In the present study, we sought to investigate the incidence and predictors of hemoptysis compared to a control group in order to determine the indicators for this complication.…”

Section: Introductionmentioning

confidence: 99%

Predictors of hemoptysis in the setting of pulmonary vein isolation using the second‐generation cryoballoon

Wei

Guo

Zhou

et al. 2018

Cardiovasc electrophysiol

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“…The potential benefit of CB‐PVI in reduction of esophageal injury compared with radiofrequency energy has not been confirmed 4. In addition, CB‐PVI may be also associated with such complications as pulmonary vein (PV) stenosis,5 hemoptysis,6 or bronchial injury 7, 8. The PV stenosis may be operator dependent in part when a cryoballoon is located too distally in the PV ostium,9 whereas hemoptysis and bronchial injury are rather anatomy dependent, given the close proximity of the bronchi and PV ostium.…”

Section: Introductionmentioning

confidence: 99%

“…4 In addition, CB-PVI may be also associated with such complications as pulmonary vein (PV) stenosis, 5 hemoptysis, 6 or bronchial injury. 7,8 The PV stenosis may be operator dependent in part when a cryoballoon is located too distally in the PV ostium, 9 whereas hemoptysis and bronchial injury are rather anatomy dependent, given the close proximity of the bronchi and PV ostium. Other mechanisms may be responsible for some of these complications, including acute elevation of pulmonary and right heart pressures during and shortly after CB-PVI; however, there are no reports concerning this topic.…”

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confidence: 99%

Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS‐Cryo Study

Lewandowski

Smarż

Sikorska

et al. 2017

JAHA

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BackgroundCryoballoon‐based pulmonary vein isolation (CB‐PVI) has been widely used for the treatment of atrial fibrillation. Although generally safe and effective, the procedure may be associated with pulmonary vein (PV) stenosis and bronchial or esophageal injury. The mechanisms leading to these complications have not been studied in detail. Our aim was to examine acute effects of cryoballoon on the pulmonary vessel and right heart pressures as well as PV wall morphology.Methods and ResultsIn 8 patients (5 men, mean age 55±14 years) undergoing CB‐PVI, pressure in each PV was measured by catheter located inside the PV directly before and after CB‐PVI. The right atrial, right ventricular, and pulmonary artery pressures as well as pulmonary arterial wedge capillary pressure in the pulmonary artery branch corresponding to target PV were also measured. Morphological changes in PVs were assessed using intravascular ultrasonography.There were no significant differences in PV pressures before and after ablation. The pulmonary arterial wedge capillary pressure significantly increased during cryoapplication (left superior: 20±10 versus 29±8.5 mm Hg, P=0.004; left inferior: 24±10 versus 32±6 mm Hg, P=0.012; right superior: 25±9 versus 35±10 mm Hg, P=0.002; right inferior: 24±10 versus 37±12 mm Hg, P=0.0036). The right atrial and pulmonary artery pressures increased significantly after CB‐PVI (9±6 versus 13±8 mm Hg, P=0.004, and 20±9 versus 24±10 mm Hg, P=0.048, respectively). Intravascular ultrasonography showed acute edema and dissection‐like changes causing relative lumen narrowing in 90% of PVs.Conclusions CB‐PVI causes significant rise in pulmonary artery and right atrial pressures as well as PV wall damage. The clinical significance of these findings warrants further investigations.

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Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury

Cited by 27 publications

References 19 publications

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Predictors of hemoptysis in the setting of pulmonary vein isolation using the second‐generation cryoballoon

Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS‐Cryo Study

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