Acute pulmonary hemorrhage during atrial fibrillation HotBalloon ablation

Fujii, Eitaro; Fujita, Satoshi; Kagawa, Yoshihiko; M, Ito

doi:10.1002/joa3.12080

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Despite continuous efforts to refine ablation strategies and titrate energy delivery, all these techniques still cause collateral damage to cardiac and extracardiac tissue, like the esophagus and the bronchus. [2][3][4][5][6][7][8][9] For this reason, delivered energy levels must be reduced, leading to decreased efficacy and subsequent durability of the ablation lesions.…”

mentioning

confidence: 99%

Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation

Füting

Reinsch

Brokkaar

et al. 2023

Circ: Arrhythmia and Electrophysiology

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Background: Thermal left atrial ablation can cause bronchial damage. Pulsed-field ablation (PFA) is a novel, nonthermal ablation modality for paroxysmal atrial fibrillation. We report on bronchial effects after pulmonary vein isolation using PFA for paroxysmal atrial fibrillation. Methods: A computed tomography scan showing the respiratory tract adjacent to the left atrial was obtained. Oral anticoagulation was interrupted on procedure day. Peri-procedurally, patients received heparin with an activated clotting time goal of >350 seconds. All pulmonary veins were individually isolated with a 13F steerable sheath and a pentaspline PFA catheter using either a straight-tip or J-tip guide wire. The J-tip guide wire patients were added to test the hypothesis that the straight-tip guidewire was associated with bleeding complications. One day afterward, bronchoscopy was performed. Serial hemoglobin levels were measured during 30-day follow-up. Results: In 2 series of 30 patients, PFA was performed, with all pulmonary veins acutely isolated. Clinical course was uneventful, no patient had chest discomfort, coughing, or hemoptysis. All patients underwent uncomplicated bronchoscopy, without thermal lesions or ulcers. In 12 out of 30 (40%) straight-tip guide wire patients, small amounts of old blood without active bleeding were seen in multiple segments. All hemoglobin levels remained clinically stable. At 30-day follow-up, all patients were asymptomatic. Conclusions: Pulmonary vein isolation using PFA for paroxysmal atrial fibrillation does not cause thermal lesions in the bronchial system. Use of a straight-tip, extrastiff guide wire for the over-the-wire PFA catheter can lead to asymptomatic bleeding in the bronchial system without clinical relevance at 30-day follow-up, opposite to use of a J-tip guide wire.

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mentioning

confidence: 99%

Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation

Füting

Reinsch

Brokkaar

et al. 2023

Circ: Arrhythmia and Electrophysiology

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“…During the balloon-based ablation, it has been reported that guidewire-related complications are rarely caused by a guidewire being positioning deep in the distal PV or left atrial appendage, as manifested by a PV hemorrhage or LA perforation. 1 , 2 The incidence is reported to be 0.35% during cryoballoon ablation, but it is unknown during HBA. 3 Electrophysiologists should always be aware of the position of the guidewire tip while advancing the balloon to prevent any PV injury or left atrial appendage perforation.…”

Section: Discussionmentioning

confidence: 99%

Successful bailout of complications during hot balloon ablation

Sawada

Nagashima

Wakamatsu

et al. 2022

HeartRhythm Case Reports

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“…Yamasaki et al reported a cardiac tamponade case needed pericardiocentesis during the LSPV isolation. In their case, the guidewire inadvertently advanced toward the left appendage and caused roof injury …”

Section: Discussionmentioning

confidence: 99%

Insights into guidewire related complication during HotBalloon ablation in patients with atrial fibrillation: What should we know?

Nakamura¹,

Sohara²,

Ihara³

2018

Journal of Arrhythmia

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A 78‐year‐old woman with drug‐resistant persistent atrial fibrillation was referred for catheter ablation by HotBalloon. All pulmonary veins were successfully ablated by the HotBalloon. During the additional roof ablation by the HotBalloon, sudden hemoptysis developed. It was observed that a guidewire advanced far distal to the left superior pulmonary vein (LSPV) branch. The pulmonary vein angiography demonstrated LSPV branch injury. After activated clotting time control, the hemoptysis disappeared spontaneously. The patient was discharged 6 days after the procedure without any sequela.

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Acute pulmonary hemorrhage during atrial fibrillation HotBalloon ablation

Cited by 3 publications

References 4 publications

Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation

Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation

Successful bailout of complications during hot balloon ablation

Insights into guidewire related complication during HotBalloon ablation in patients with atrial fibrillation: What should we know?

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