1
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Wang YJ, Sun H, Fan XF, Zhang MC, Yang P, Zeng H, Liu L. Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT. BMC Cardiovasc Disord 2021; 21:84. [PMID: 33568060 PMCID: PMC7877049 DOI: 10.1186/s12872-021-01881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures. METHODS Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured. RESULTS The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001). CONCLUSIONS The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.
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Affiliation(s)
- Yan-Jing Wang
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Huan Sun
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China
| | - Xiao-Fei Fan
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Meng-Chao Zhang
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China
| | - Ping Yang
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China
| | - Hong Zeng
- Cardiology Department, Cardiovascular Institute of Jilin Province, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China. .,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, 130031, Jilin Province, China.
| | - Lin Liu
- Radiology Department, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130031, Jilin Province, China.
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Andrade JG, Cheung CC, Deyell MW. Hemoptysis and Cryoballoon Ablation: Is it Crystal Clear? JACC Clin Electrophysiol 2020; 6:783-785. [PMID: 32703559 DOI: 10.1016/j.jacep.2020.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada.
| | - Christopher C Cheung
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada
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3
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Vogler J, Fink T, Sohns C, Sommer P, Pott A, Dahme T, Rottner L, Sciacca V, Sieren MM, Jacob F, Barkhausen J, Sano M, Eitel C, Metzner A, Ouyang F, Kuck KH, Tilz RR, Heeger CH. Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation. JACC Clin Electrophysiol 2020; 6:773-782. [DOI: 10.1016/j.jacep.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
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4
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Aryana A, Braegelmann KM, Lim HW, Ellenbogen KA. Cryoballoon ablation dosing: From the bench to the bedside and back. Heart Rhythm 2020; 17:1185-1192. [PMID: 32142876 DOI: 10.1016/j.hrthm.2020.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
To date, multiple modes of research have been leveraged to study the optimal cryoballoon ablation parameters to safely, effectively, and efficiently isolate the pulmonary veins for the treatment of atrial fibrillation. Basic scientific investigation, preclinical studies, clinical observations, trials, and, more recently, computational modeling have helped to generate and test new hypotheses for the advancement of cryoballoon treatment in patients with atrial fibrillation. In this review, we examine the data and evidence that have contributed to the development of patient-tailored dosing strategies that are currently used for pulmonary vein isolation by using the Arctic Front series of cryoballoon ablation catheters.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | | | - Hae W Lim
- Medtronic, Inc, Minneapolis, Minnesota
| | - Kenneth A Ellenbogen
- Division of Clinical Cardiac Electrophysiology and Pacing, Virginia Commonwealth University Health System, Richmond, Virginia
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5
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Trotta O, Alarcón F, Guasch E, Benito EM, San Antonio R, Perea RJ, Prat-Gonzalez S, Apolo J, Sitges M, Tolosana JM, Mont L. Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:638-646. [PMID: 31957087 DOI: 10.1111/jce.14358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 01/20/2023]
Abstract
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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Affiliation(s)
- Omar Trotta
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco Alarcón
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Guasch
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Maria Benito
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosario J Perea
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susanna Prat-Gonzalez
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose Apolo
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José María Tolosana
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluís Mont
- Cardiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Yoshiga Y, Okamoto T, Shimizu A, Ueyama T, Ono M, Mito T, Fukuda M, Ishiguchi H, Omuro T, Kobayashi S, Goto A, Nishikawa J, Sakaida I, Yano M. Correlation between asymptomatic gastroesophageal excessive transmural injury after pulmonary vein isolation and a bonus freeze protocol using the second-generation 28-mm cryoballoon for paroxysmal atrial fibrillation. J Cardiol 2019; 74:494-500. [DOI: 10.1016/j.jjcc.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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7
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Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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8
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Giaretto V, Ballatore A, Passerone C, Desalvo P, Matta M, Saglietto A, De Salve M, Gaita F, Panella B, Anselmino M. Thermodynamic properties of atrial fibrillation cryoablation: a model-based approach to improve knowledge on energy delivery. J R Soc Interface 2019; 16:20190318. [PMID: 31530136 DOI: 10.1098/rsif.2019.0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objective of this study is to describe a suitable model of atrial fibrillation cryoablation thermodynamic properties. Three different thermal loads were applied to a cylindrical copper element simulating the cryoprobe, thermally coupled with a Peltier stack producing the freezing effect, and in contact with a bovine liver sample. Thermal events occurring inside the samples were measured using mirror image technique. Heat subtracted flux during ice formation and minimum temperature measured at probe-tissue interface were, respectively, 1.33 W cm-2 and -27.8°C for Sample#0, 1.88 W cm-2 and -35.6°C for Sample#1 and 1.82 W cm-2 and 1.44 W cm-2 before and after the ice trigger, respectively, and -29.3°C for Sample#2. Ice trigger temperature was around -8.5°C for Sample#0 and Sample#2, and -10.4°C for Sample#1. In all the investigated samples, ice front penetration was proportional to the square root of time and its velocity depended on the heat flux subtracted. The fraction of the useful energy spent for ice formation was less than 60% for Sample#0, and about 80% for Sample#1 and for Sample#2, before the reduction of the removed heat flux. Freezing time exceeding a cut-off, according to the heat subtracted flux, does not improve the procedure effectiveness and is detrimental to the surrounding tissues.
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Affiliation(s)
| | - Andrea Ballatore
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Passerone
- Department of Electronics and Telecommunications, Politecnico di Torino, Italy
| | - Paolo Desalvo
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Matta
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Fiorenzo Gaita
- Department of Cardiology, Clinica Pinna Pintor, Turin, Italy
| | | | - Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
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9
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Miyamoto K, Doi A, Hasegawa K, Morita Y, Mishima T, Suzuki I, Kaseno K, Nakajima K, Kataoka N, Kamakura T, Wada M, Yamagata K, Ishibashi K, Inoue YY, Nagase S, Noda T, Aiba T, Asakura M, Izumi C, Noguchi T, Tada H, Takagi M, Yasuda S, Kusano KF. Multicenter Study of the Validity of Additional Freeze Cycles for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 12:e006989. [DOI: 10.1161/circep.118.006989] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Koji Miyamoto
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan (A.D.)
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, University of Fukui, Yoshida, Japan (K.H., K.K., H.T.)
| | - Yoshiaki Morita
- Department of Radiology (Y.M.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsuyoshi Mishima
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, National Hospital Organization Osaka National Hospital, Japan (T.M.)
| | - Ippei Suzuki
- Department of Data Science (I.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, University of Fukui, Yoshida, Japan (K.H., K.K., H.T.)
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoya Kataoka
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuko Y. Inoue
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masanori Asakura
- Department of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Japan (M.A.)
| | - Chisato Izumi
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui, Yoshida, Japan (K.H., K.K., H.T.)
| | - Masahiko Takagi
- Department of Medicine II, Kansai Medical University, Hirakata, Japan (M.T.)
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo F. Kusano
- Department of Cardiovascular Medicine (K.M., T.M., K.N., N.K., T.K., M.W., K.Y., K.I., Y.Y.I., S.N., T.N., T.A., C.I., T.N., S.Y., K.F.K.), National Cerebral and Cardiovascular Center, Suita, Japan
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10
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Lee JM, Jeong DS, Yu HT, Park HS, Shim J, Kim JY, Kim J, Yoon NS, Oh S, Roh SY, Cho YJ, Kim KH. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part III. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Hemoptysis as a side effect of cryoballoon pulmonary vein isolation in atrial fibrillation: a retrospective case-control study. J Interv Card Electrophysiol 2018; 54:231-236. [DOI: 10.1007/s10840-018-0468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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12
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Wei HQ, Guo XG, Zhou GB, Sun Q, Yang JD, Luo B, Ma J. Predictors of hemoptysis in the setting of pulmonary vein isolation using the second-generation cryoballoon. J Cardiovasc Electrophysiol 2018; 29:958-965. [PMID: 29858877 DOI: 10.1111/jce.13644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To assess the predictors of hemoptysis using second-generation cryoballoon (CB). METHODS Thirty patients with hemoptysis after second-generation CB ablation and 60 age-, gender-, and body mass index-matched controls were recruited. Anatomic parameters were obtained from preprocedural cardiac computed tomography (CT). Pulmonary vein isolation was performed with 28-mm balloon using single 3-minute freeze technique. RESULTS Clinical and procedural characteristics were similar between the groups. A shorter distance between left superior PV (LSPV) and left main bronchus (LMB) was associated with hemoptysis (7.8 ± 4.3 mm vs. 12.5 ± 3.5 mm, P < 0.001), whereas no significant difference in the distance between right superior PV (RSPV) and right main bronchus (RMB) was found between groups (11.9 ± 3.5 mm vs. 12.9 ± 4.6 mm, P = 0.089). Additionally, the mean thickness of the connective tissue interposed between RSPV and RMB was significantly thicker than that between LSPV and LMB in both groups (both P < 0.001). A stepwise logistic multivariate analysis identified only the LMB-LSPV distance as an independent predictor of hemoptysis (odd ratio [OR] 2.676; 95% CI 1.121-4.843, P < 0.001). A cutoff value ≤ 9.5 mm predicted hemoptysis after CB ablation with 93.8% sensitivity and 75.0% specificity. CONCLUSION Hemoptysis is a relatively rare event following second-generation CB ablation. The bronchi location obtained from CT aids in identifying high-risk population for the complication.
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Affiliation(s)
- Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Su W, Aryana A, Passman R, Singh G, Hokanson R, Kowalski M, Andrade J, Wang P. Cryoballoon Best Practices II: Practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users. Heart Rhythm 2018; 15:1348-1355. [PMID: 29684571 DOI: 10.1016/j.hrthm.2018.04.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 10/17/2022]
Abstract
Since the evaluation of the cryoballoon in the Sustained Treatment Of Paroxysmal Atrial Fibrillation trial, more than 350,000 patients with atrial fibrillation have been treated. Several studies have reported improved outcomes using the second-generation cryoballoon, and recent publications have evaluated modifications, refinements, and improvements in procedural techniques. Here, peer-reviewed articles published since the first cryoballoon best practices review were summarized against the technical practices of physicians with a high level of experience with the cryoballoon (average ≥6 years of experience in ≥900 cases). This summary includes a comprehensive literature review along with practical usage guidance from physicians using the cryoballoon to facilitate safe, efficient, and effective outcomes for patients with atrial fibrillation.
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Affiliation(s)
- Wilber Su
- Banner University Medical Center, Phoenix, Arizona; Stanford Health Care, Stanford, California.
| | - Arash Aryana
- Mercy Medical Group, Dignity Health Heart & Vascular Institute, Sacramento, California
| | - Rod Passman
- Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Jason Andrade
- Montreal Heart Institute, Montreal, Quebec, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Wang
- Stanford Health Care, Stanford, California
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Liang JJ, Ma J. "Crosstalk" technique: A comparison between two generations of cryoballoon catheter. Pacing Clin Electrophysiol 2018; 41:635-642. [PMID: 29603258 DOI: 10.1111/pace.13336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The "Crosstalk" technique: if pulmonary vein isolation (PVI) of the superior one is not achieved due to a gap in the inferior part, it could be done during inferior vein cryoablation. This maneuver minimizes the total energy delivery time and number of lesions. We aimed to correlate the likelihood of crosstalk phenomenon with certain anatomic characteristics. METHODS A total of 676 patients undergoing a first ablation procedure for paroxysmal or persistent atrial fibrillation (470 first-generation cryoballoon [CB] and 206 second-generation CB) between June 2014 and December 2016 were included. RESULTS "Crosstalk" phenomenon occurred in 32 patients (18 first-generation CB, 14 second-generation CB). Compared to 54 control patients without crosstalk, the angle between left superior pulmonary vein (LSPV) and left atrial (LA) roof-plane, left pulmonary common ostia were significant parameters associated with crosstalk (odds ratio [OR] = 1.20, ±95% confidence interval [CI]: 1.11-1.31, P < 0.001; OR = 5.67, ±95% CI: 1.08-28.69, P = 0.04). As for angle between LSPV and LA roof-plane, the cut-off value was 28.68° with a sensitivity of 72.22%, a specificity of 81.25%, and an area under the receiver operating characteristic curve of 0.87 to predict the possibility of crosstalk technique application to get isolated in LSPV. Among the crosstalk group, there was no statistical difference between first-generation CB and second-generation CB in pulmonary anatomic characteristics. CONCLUSION Crosstalk technique can be effective in patients with AF undergoing CB ablation using with both first and second-generation CBs. Anatomic characteristics predictive of crosstalk include a left common ostia and smaller angle between the LSPV and LA roof-plane.
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Affiliation(s)
- Jian-du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Bellmann B, Hübner RH, Lin T, Paland M, Steiner F, Krause P, Tscholl V, Nagel P, Roser M, Suttorp N, Landmesser U, Rillig A. Bronchial Injury After Atrial Fibrillation Ablation Using the Second-Generation Cryoballoon. Circ Arrhythm Electrophysiol 2018; 11:e005925. [DOI: 10.1161/circep.117.005925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barbara Bellmann
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Ralf-Harto Hübner
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Tina Lin
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Matthias Paland
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Florian Steiner
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Phillip Krause
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Verena Tscholl
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Patrick Nagel
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Mattias Roser
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Norbert Suttorp
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Ulf Landmesser
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
| | - Andreas Rillig
- From the Department of Cardiology (B.B., V.T., P.N., M.R., U.L., A.R.) and Department of Pneumology (R.-H.H., M.P., F.S., P.K., N.S.), Charité–Universitätsmedizin Berlin, University Hospital Berlin, Germany; and Heartcare Victoria, Melbourne, Australia (T.L.)
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16
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Verma N, Gillespie CT, Argento AC, Tomson T, Dandamudi S, Piña P, Ringwala S, Lin AC, Chicos AB, Kim S, Arora R, Passman RS, Knight BP. Bronchial effects of cryoballoon ablation for atrial fibrillation. Heart Rhythm 2018; 14:12-16. [PMID: 28007093 DOI: 10.1016/j.hrthm.2016.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Damage to extracardiac structures, including the esophagus and phrenic nerve, is a known complication of cryoballoon ablation (CBA) during pulmonary vein (PV) isolation for atrial fibrillation (AF). Other adjacent structures, including the pulmonary bronchi and lung parenchyma, may be affected during CBA at the PV ostia. OBJECTIVE The purpose of this study was to prospectively study the bronchial effects of CBA in humans undergoing CBA for PV isolation. METHODS Ten patients undergoing CBA for AF under general anesthesia were enrolled in an institutional review board-approved prospective observational study. Real-time bronchoscopy was performed during cryoablation of PVs adjacent to pulmonary bronchi to monitor for thermal injury. Patients were followed for the development of respiratory complaints postprocedure. RESULTS In 7 of 10 patients (70%) and in 13 of 22 freezes (59%), ice formation was visualized in the left mainstem bronchus during CBA in the left upper PV. Ice formation was not seen in the right mainstem bronchus during right upper PV CBA. The average time to ice formation was 89 seconds. There was no significant difference (P = -.45) in average minimum balloon temperature during freezes with ice formation (-48.5°C) and freezes without ice formation (-46.3°C). No patients went on to develop respiratory complications. CONCLUSION Unrecognized ice formation occurs frequently in the left mainstem bronchus during CBA for AF. This information helps explain the source of cough and hemoptysis in some patients who undergo CBA. The long-term consequences of this novel finding and the implications for procedural safety are unknown.
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Affiliation(s)
- Nishant Verma
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
| | - Colin T Gillespie
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - A Christine Argento
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Todd Tomson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sanjay Dandamudi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Paloma Piña
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sukit Ringwala
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Albert C Lin
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Susan Kim
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Rishi Arora
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
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17
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 708] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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18
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Kulkarni N, Su W, Wu R. How to Prevent, Detect and Manage Complications Caused by Cryoballoon Ablation of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2018; 7:18-23. [PMID: 29636968 DOI: 10.15420/aer.2017.32.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is increasing every year. Patients who fail to maintain sinus rhythm with use of anti-arrhythmic drug therapy are referred for catheter ablation. Cryoballoon (CB) ablation has emerged as an effective and alternative treatment option to traditional point-by-point radiofrequency ablation, but there can be complications. This article reviews the incidence, presentation, risk factors, management and preventative strategies of three major complications associated with CB ablation: phrenic nerve injury, atrial oesophageal fistula and bronchial injury. Although these complications are rare, electrophysiologists should institute measures to identify high-risk patients, implement best-practice techniques to minimise risks and maintain a high index of suspicion to recognise the complications quickly and implement correct treatment strategies.
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Affiliation(s)
- Nitin Kulkarni
- University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Wilber Su
- Banner University Medical Center, University of ArizonaPhoenix, AZ, USA
| | - Richard Wu
- University of Texas Southwestern Medical CenterDallas, TX, USA
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19
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1370] [Impact Index Per Article: 195.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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20
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Aryana A, Kenigsberg DN, Kowalski M, Koo CH, Lim HW, O'Neill PG, Bowers MR, Hokanson RB, Ellenbogen KA. Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance). Heart Rhythm 2017. [DOI: 10.1016/j.hrthm.2017.06.020] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Baran J, Lewandowski P, Smarż K, Sikorska A, Zaborska B, Kułakowski P. Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS-Cryo Study. J Am Heart Assoc 2017. [PMID: 28649087 PMCID: PMC5669196 DOI: 10.1161/jaha.117.005988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Cryoballoon‐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 Results In 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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Affiliation(s)
- Jakub Baran
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Paweł Lewandowski
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Krzysztof Smarż
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Beata Zaborska
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
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23
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Walsh KA, Keane D, Fahy GJ. Relationship of the lungs to the left atrium of particular relevance for ablation of atrial fibrillation. J Interv Card Electrophysiol 2017; 49:21-25. [PMID: 28357713 DOI: 10.1007/s10840-017-0245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Symptoms of possible lung and pleural injury such as chest pain and hemoptysis occur during and after radiofrequency ablation (RFA) and cryoablation (CA) of the left atrium (LA) for treatment of atrial fibrillation (AF). We determined the anatomical relationship of the lungs to the LA with particular reference to areas commonly targeted during AF ablation. METHODS Distances from the LA endocardium to the lungs were measured from pre-procedure CT angiograms of 100 consecutive patients (71 males, age 60 ± 8 years) who underwent AF ablation. RESULTS In 97% of the patients, the posterior right pulmonary vein antrum was <5 mm from the lower lobe of the right lung (RLL) over a supero-inferior distance of 3.6 ± 1.5 cm (minimum distance 1.2 ± 0.7 mm). The right inferior pulmonary vein (RIPV) ostium was <5 mm from the RLL in 94% (mean 2.7 ± 1.9 mm). The right superior pulmonary vein ostium was <5 mm from the RLL in 29% (mean 7.1 ± 3.8 mm). The medial segment of the right middle lobe was <5 mm from the carina between right pulmonary veins in 83% (mean 3.6 ± 1.9 mm). The mitral isthmus was <5 mm from the lingula in 5% (mean 9.4 ± 3.6 mm). The inferior lobe of the left lung was <5 mm from the posterior aspect of the ostia of the left inferior and superior pulmonary veins in 9 and 0%, respectively. The bronchi were <5 mm from the LA in 5%. CONCLUSIONS The lungs are intimately related to sites of the LA commonly targeted during AF RFA. Whether this anatomical proximity translates into clinically significant potential for collateral lung damage during RFA merits further study.
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Affiliation(s)
- Katie A Walsh
- Department of Cardiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - David Keane
- Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Gerard J Fahy
- Department of Cardiology, Cork University Hospital, Wilton, Cork, Ireland
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24
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Freezing for the future: Next generation of cryoballoon for the treatment of atrial fibrillation. Heart Rhythm 2016; 13:2314-2315. [PMID: 27574982 DOI: 10.1016/j.hrthm.2016.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 11/23/2022]
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