Incidence and characteristics of complications in the setting of second-generation cryoballoon ablation: A large single-center study of 500 consecutive patients

Mugnai, Giacomo; Asmundis, Carlo de; Ciconte, Giuseppe; Irfan, Ghazala; Saitoh, Yukio; Velagić, Vedran; Ströker, Erwin; Wauters, Kristel; Hünük, Burak; Brugada, Pedro; Chierchia, Gian Battista

doi:10.1016/j.hrthm.2015.04.001

Cited by 58 publications

(49 citation statements)

References 21 publications

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“…51 However, subsequent studies have found rates of phrenic nerve palsy ranging from 3.5% to 10%, with most cases being transient and resolving by the end of the procedure. 52 As many as two thirds of patients recover phrenic nerve function before discharge. 52 Several techniques can be used to limit PN injury, including PN pacing with visual observation of diaphragmatic excursion or electromyography.…”

Section: Unipolarmentioning

confidence: 99%

See 1 more Smart Citation

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

Barnett

Bahnson

Piccini

2016

Circ: Arrhythmia and Electrophysiology

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Section: Unipolarmentioning

confidence: 99%

“…52 As many as two thirds of patients recover phrenic nerve function before discharge. 52 Several techniques can be used to limit PN injury, including PN pacing with visual observation of diaphragmatic excursion or electromyography.…”

Section: Unipolarmentioning

confidence: 99%

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

Barnett

Bahnson

Piccini

2016

Circ: Arrhythmia and Electrophysiology

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“…These outcomes are in contrast to longterm follow-up studies of CB-A ablation in which palpation of diaphragmatic contraction was the primary monitoring strategy. These studies uniformly reported some long-lasting PN injury beyond 1 year (12)(13)(14)16,26).…”

Section: Stop-af (Study Of the Arctic Front Cryoablationmentioning

confidence: 99%

“…Several case series describe exclusive use of the large 28-mm CB-A, which minimizes the likelihood that the balloon catheter will be advanced into the right superior PV (5,(11)(12)(13)(14)(15), and more recent reports describe shortening the delivery time to 180 s and avoiding "bonus" ablation after isolation is achieved (5,16). Monitoring diaphragmatic compound motor action potential (CMAP) amplitude has also been reported as a valuable adjunct to palpating diaphragmatic contraction during PN pacing.…”

Section: Stop-af (Study Of the Arctic Front Cryoablationmentioning

confidence: 99%

Preventing Phrenic Nerve Injury During Second Generation Cryoballoon Ablation

Bahnson

2016

JACC: Clinical Electrophysiology

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“…Recent randomized clinical studies1 and meta‐analyses2 showed comparable outcomes for CB‐PVI and standard radiofrequency PVI; however, both procedures are associated with the risk of complications. Right phrenic nerve palsy occurs almost exclusively following CB‐PVI 3. The potential benefit of CB‐PVI in reduction of esophageal injury compared with radiofrequency energy has not been confirmed 4.…”

Section: Introductionmentioning

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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Incidence and characteristics of complications in the setting of second-generation cryoballoon ablation: A large single-center study of 500 consecutive patients

Cited by 58 publications

References 21 publications

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

Preventing Phrenic Nerve Injury During Second Generation Cryoballoon Ablation

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

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