Bronchial effects of cryoballoon ablation for atrial fibrillation

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9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)12-16
Number of pages5
JournalHeart Rhythm
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Ice
Pulmonary Veins
Atrial Fibrillation
Bronchi
Lung
Phrenic Nerve
Cryosurgery
Hemoptysis
Bronchoscopy
Cough
General Anesthesia
Esophagus
Observational Studies
Hot Temperature
Prospective Studies
Safety
Temperature
Wounds and Injuries

Keywords

  • AF ablation
  • Atrial fibrillation
  • Bronchoscopy
  • Cryoablation
  • PV isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{18cfdeeb77944c68b0bbda1aba6ca87d,
title = "Bronchial effects of cryoballoon ablation for atrial fibrillation",
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.",
keywords = "AF ablation, Atrial fibrillation, Bronchoscopy, Cryoablation, PV isolation",
author = "Nishant Verma and Gillespie, {Colin Thomas} and Argento, {Angela Christine} and Todd Tomson and Sanjay Dandamudi and Paloma Pi{\~n}a and Sukit Ringwala and Lin, {Albert Chao-tun} and Chicos, {Alexandru Bogdan} and {Kim Koss}, {Susan S} and Arora, {Rishi K} and Passman, {Rod S} and Knight, {Bradley Paul}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.hrthm.2016.10.012",
language = "English (US)",
volume = "14",
pages = "12--16",
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T1 - Bronchial effects of cryoballoon ablation for atrial fibrillation

AU - Verma, Nishant

AU - Gillespie, Colin Thomas

AU - Argento, Angela Christine

AU - Tomson, Todd

AU - Dandamudi, Sanjay

AU - Piña, Paloma

AU - Ringwala, Sukit

AU - Lin, Albert Chao-tun

AU - Chicos, Alexandru Bogdan

AU - Kim Koss, Susan S

AU - Arora, Rishi K

AU - Passman, Rod S

AU - Knight, Bradley Paul

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - AF ablation

KW - Atrial fibrillation

KW - Bronchoscopy

KW - Cryoablation

KW - PV isolation

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U2 - 10.1016/j.hrthm.2016.10.012

DO - 10.1016/j.hrthm.2016.10.012

M3 - Article

VL - 14

SP - 12

EP - 16

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 1

ER -