Early hyperbaric oxygen therapy for cerebral air embolism during atrial fibrillation ablation

Clinically Manifesting Air Embolisms in Cryoballoon Ablation: Can Novel Water Buckets Reduce the Risk?

Air embolisms can lead to lethal results; however, few reports have systemically investigated this issue. Of 348 consecutive patients with atrial fibrillation who underwent cryoballoon ablation, procedures were performed conventionally in 251 patients. In the remaining 97 patients, a water bucket was used while inserting the cryoballoon into the sheath. A total of 10 coronary air embolisms with ST-segment elevation in the inferior leads were observed among 9 (2.6%) patients. Multiple air bubbles were identified in 2 patients on emergent coronary angiography. All recovered under conservative treatment without any sequela. The incidence decreased when using the water bucket (1 of 97 [1.03%] vs. 8 of 251 [3.2%], p = 0.454).

[It's all over! : Complications in the EP lab and their solutions]

In cardiac electrophysiology, invasive procedures like catheter ablations or device implantations are getting increasingly complex. This poses challenges especially for electrophysiologists in training, not only to learn how to perform the procedure, but also how to manage possible complications. The present article uses exemplary case studies to present how to control complications and how to avoid them. The presented cases deal with complications such as air embolism in left atrial procedures, iatrogenic vascular injuries such as aortic dissection or dissection of the coronary sinus, complications and challenges with lead revisions, and pericardial tamponade. In each case, measures for avoidance as well as practical guidance for management are shown when the respective complication occurs.