Complications of Cryoballoon Pulmonary Vein Isolation

Abstract

Since the cryoballoon (CB) was introduced into clinical practice, more than 400,000 patients have undergone a pulmonary vein (PV) isolation with a CB throughout the world. Although the efficacy of the first-generation CB was limited, the recently introduced secondgeneration CB has achieved a greater uniformity in cooling, which has facilitated a shorter time to PV isolation, shorter procedural times, higher rates of freedom from atrial fibrillation and low rates of PV reconnections. Currently, a single short freeze strategy with a single 28 mm balloon has become the standard technique based on the balance of procedural efficacy and safety. However, enhanced cooling characteristics may also result in a greater potential for collateral damage to non-cardiac structures. Knowledge about the potential complications is essential when performing the procedure. In this article, we describe the important complications that should be noted during a CB procedure, and how to minimise the risk of complications based on our experience.

Long‐term outcomes of a time to isolation – based strategy for cryoballoon ablation compared to radiofrequency ablation in patients with symptomatic paroxysmal atrial fibrillation

“…In terms of safety, our dosing protocol certainly reduced the number of cryoapplications and shortened the duration of cryoablation compared to the standard CBA protocol, thereby decreasing the possibility of procedure‐related complications. Importantly, the occurrence of complications, such as oesophageal injury, atrio‐oesophageal fistulae, and air embolism, increases with the increasing duration of the procedure and cryoablation 12 . In our study, patients undergoing CBA showed a low rate of complications, especially life‐threatening complications, which were consistent with remarkable trials 1,2 .…”

Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?

“…Of the 48 patients treated with this technique at our hospital, none experienced complications related to the procedure under routine clinical settings. Although complete isolation of the LAPW is desirable, repetitive wide LAPW ablation might lead to phrenic nerve injury, esophageal damage, or autonomic nerve injury, which could affect the regulation of the esophagus . Therefore, reducing the complications via reduced ablation is unsurprising.…”

Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

“…PVI with the single-shot cryoballoon technique is a frequently used strategy [6]. It is a safe and effective procedure with known complications such as phrenic nerve palsy, access site complications, thromboembolic events and cardiac tamponade [7,8].…”