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Shehadeh M, Wan EY, Biviano A, Mollazadeh R, Garan H, Yarmohammadi H. Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation. J Interv Card Electrophysiol 2024; 67:409-424. [PMID: 38038816 DOI: 10.1007/s10840-023-01708-4] [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: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Esophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication. METHODS We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review. RESULTS A total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5-40%, cryoballoon 3-25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention. CONCLUSIONS Esophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.
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Affiliation(s)
- Malik Shehadeh
- Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami, FL, USA
| | - Elaine Y Wan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Angelo Biviano
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Reza Mollazadeh
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Garan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA.
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Metzner A, Sultan A, Futyma P, Richter S, Perrotta L, Chun KRJ. Prevention and treatment of pericardial tamponade in the electrophysiology laboratory: a European Heart Rhythm Association survey. Europace 2023; 26:euad378. [PMID: 38163951 PMCID: PMC10787481 DOI: 10.1093/europace/euad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS Pericardial tamponade (PT) is the most frequent severe complication during electrophysiology (EP) procedures and requires immediate, co-ordinated, and effective treatment. However, multiple aspects of PT treatment are either not standardized or are under ongoing debate. METHODS AND RESULTS An online questionnaire consisting of 26 multiple-choice questions was sent out to the European Heart Rhythm (EHRA) Research Network and also distributed via social media outputs. The EHRA survey was conducted between May and June 2023. A total of 213 replies were received from European (87%) and non-European countries. Ninety per cent of all participants perform interventions in dedicated EP labs equipped with different ablation platforms. In case of PT, most participants use X-ray as the main imaging modality guiding pericardial puncture, predominantly aiming for an anterior puncture site. Sheaths of different sizes are introduced into the pericardial space (84.3%), followed by a pigtail catheter. Application of protamine is an established but variable step in the majority (84.6%). Novel oral anticoagulants (NOAC) antidotes are not used by 73.3% of participants, while 15.2% routinely apply them. Re-transfusion of aspirated blood is performed by 72.1% [before protamine administration (18.2%), after protamine administration (13.5%), if pericardial effusion cannot be controlled (40.4%)]. A total of 72.4% re-transfuse without blood filter systems. A decision for surgical intervention is mostly taken if bleeding continues despite all interventional measures. CONCLUSION The current survey demonstrates that the management of PT is heterogeneous among centres. The findings of this survey may help to guide operators in their treatment and decisions in the setting of PT.
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 51, 20246 Hamburg, Germany
| | - Arian Sultan
- Department of Cardiology, University Heart Center Cologne, Cologne, Germany
| | - Piotr Futyma
- St. Joseph’s Heart Rhythm Center Rzeszow and Medical College, University of Rzeszow, Rzeszow, Poland
| | - Sergio Richter
- Heart Center Dresden, University Hospital, Technical University Dresden, Dresden, Germany
| | - Laura Perrotta
- Department of Cardiology, Careggi University Hospital, Florence, Italy
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Pongratz J, Kuniss M, Wu L, Tebbenjohanns J, Nölker G, Dorwarth U, Kuck KH, Jochen S, Hoffmann E, Straube F. Impact of intracardiac echocardiography usage on the safety of cryoballoon atrial fibrillation ablation: Subanalysis of the prospective FREEZE cluster cohort study. J Cardiovasc Electrophysiol 2023; 34:2029-2039. [PMID: 37681996 DOI: 10.1111/jce.16060] [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: 06/09/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) aiming at pulmonary vein isolation (PVI) became a standardized atrial fibrillation (AF) ablation procedure. Life-threatening complications like cardiac tamponade exist. Intracardiac echocardiography (ICE) usage is associated with superior safety in radiofrequency ablation. It is unclear if ICE has an impact on safety of CBA. METHODS The FREEZE Cohort (NCT01360008) subanalysis included patients undergoing "PVI only" CBA. Patients with intraprocedural transesophageal echocardiography were excluded. Group A comprises conventional, group B ICE-guided CBA. Periprocedural results were compared. RESULTS From 2011 to 2016, a total of 4189 patients were enrolled, and 1906 (45.5%) were included in this subanalysis, split up in two groups (A: 1066 [55.9%], B: 840 [44.1%]). Group A was younger (60.6 ± 10.8 vs. 62.4 ± 10.5 years, p < .001), with smaller left atria (41 vs. 43 mm, p < .001), and less persistent AF (23.1 vs. 38.1%, p < .001). Procedure, left atrial, and fluoroscopy times were shorter in group A as compared to group B. Dose area product was significantly higher in group A (2911 vs. 2072 cGyxcm2 , p < .001). In-hospital major adverse cerebrovascular and cardiac event rates including two deaths in group A were not different between groups (0.5% vs. 0.1%, p = .18). The rate of total procedural (10.4% vs. 5.1%, p < .001) and major complications (3.2% vs. 1.3%, p < .001) was significantly higher in group A. Cardiac tamponade occurred significantly more frequently in group A (8 [0.8%] vs. 1 [0.1%], p = .046). Independent predictors for major complications were female sex (odds ratio [OR] 2.03, p = .03) and non-ICE usage (OR 2.38, p = .02). No differences were observed for persistent phrenic nerve palsy, nor for groin complications. CONCLUSION CBA was significantly safer and required less radiation if ICE was used, although the procedures were more complex. The risk of groin complications was not increased with ICE usage. Non-ICE usage was the only modifiable independent predictor of major complications.
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Affiliation(s)
- Janis Pongratz
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Germany
| | - Liqun Wu
- Department of Cardiology, Shanghai Rui Jin Hospital, Shanghai, People's Republic of China
| | | | - Georg Nölker
- Innere Klinik II/Kardiologie, Christliches Klinikum Unna-Mitte, Unna, Germany
| | - Uwe Dorwarth
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Karl-Heinz Kuck
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | - Ellen Hoffmann
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
| | - Florian Straube
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, München, Bavaria, Germany
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Nentwich K, Ene E, Halbfass P, Berkowitz A, Sonne K, Kerber S, Lee R, Deneke T. Concomitant epicardial left atrial appendage ligation and left atrial ablation of atrial fibrillation: Safety, feasibility and outcome. Indian Pacing Electrophysiol J 2021; 21:75-79. [PMID: 33460777 PMCID: PMC7952894 DOI: 10.1016/j.ipej.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction We present initial results of patients undergoing a combined procedure of epicardial LAA ligation in addition to left atrial ablation for AF. Methods 9 patients were included for additional use of LARIAT as an individual treatment approach for AF. First an epicardial LAA ligation was performed, in the same procedure left atrial ablations consisting of PVI and additional substrate based modifying ablations were performed. Follow–up at 3 months and 12 months was performed. Results There was only 1 minor procedural complication (11%) involving epicardial bleeding and 2 late adverse events of pericardial tamponade and stroke. At the final follow-up (median 20 months) 7 patients were in stable sinus rhythm (78%) and 2 pts had reduced AF burden. Conclusion Concomitant epicardial LAA ligation and ablation is feasible in selected patients with a reasonable risk profile. More prospective data are required to validate the safety and efficacy.
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Affiliation(s)
- Karin Nentwich
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany.
| | - Elena Ene
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Philipp Halbfass
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Arthur Berkowitz
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Kai Sonne
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Sebastian Kerber
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
| | - Randall Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, 500 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Thomas Deneke
- Campus Bad Neustadt, Department Cardiology and Invasive Electrophysiology, von Guttenbergstrasse 11, 97616, Bad Neustadt, Germany
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Varnavas V, Terasawa M, Sieira J, Abugattas JP, Ströker E, Paparella G, Iacopino S, Maj R, Osorio TG, De Greef Y, Bala G, Overeinder I, Brugada P, de Asmundis C, Chierchia GB. Electrophysiological findings in patients with isolated veins after cryoablation for paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2020; 21:641-647. [PMID: 32740497 DOI: 10.2459/jcm.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The main cause of atrial fibrillation recurrence after catheter ablation is pulmonary vein reconnection. The purpose of this retrospective study was to analyse the electophysiological findings in patients undergoing repeat procedures after an index cryoballoon ablation (CB-A) and presenting with permanency of pulmonary vein isolation (PVI) in all veins. In addition, we sought to compare the latter with a similar group of patients with reconnected veins at the redo procedure. METHODS A total of 132 patients (81 men, 60.7 ± 12.4 years) who underwent CB-A for paroxysmal atrial fibrillation (PAF) were enrolled. Indication for the redo procedure was symptomatic PAF in 83 (63%), persistent atrial fibrillation (PerAF) in 32 (24%) or persistent regular atrial tachycardia (RAT) in 17 (13%) patients. RESULTS Seventy-five (57%) patients presented a pulmonary vein reconnection (pulmonary vein group) during the redo procedure, whereas 57 (43%) had no pulmonary vein reconnection (non-pulmonary vein group). The non-pulmonary vein group exhibited significantly more non-pulmonary vein foci and atrial flutters than the pulmonary vein group after induction protocol (51 vs. 24%, P = 0.002 and 67 vs. 36%, P = 0.003, respectively). Twenty-two (29.3%) patients of the pulmonary vein group and 20 (35%) patients of the non-pulmonary vein group had atrial fibrillation/RAT recurrence after a mean follow-up of 12.5 ± 8 months. The survival analysis demonstrated no statistical significance in recurrence between both groups (log rank P = 0.358). CONCLUSION Atrial fibrillation/RAT recurrence in patients after CB-A with durable PVI is significantly associated with non-pulmonary vein foci and atrial flutters. No statistically different success rate regarding atrial fibrillation/RAT freedom was detected between the pulmonary vein and non-pulmonary vein groups after redoing RF-CA.
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Affiliation(s)
- Varnavas Varnavas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Juan Pablo Abugattas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | | | | | - Saverio Iacopino
- Electrophysiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Riccardo Maj
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Thiago Guimarães Osorio
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | | | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels
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Do U, Kim J, Kim M, Cho MS, Nam GB, Choi KJ, Kim YH. Association of pericardial effusion after pulmonary vein isolation and outcomes in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1132-1138. [PMID: 32840867 DOI: 10.1111/pace.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/04/2020] [Accepted: 08/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical implications of pericardial effusion (PE) after catheter ablation for atrial fibrillation (AF) are not well understood. We evaluated the association between newly developed PE after pulmonary vein isolation (PVI) for paroxysmal AF and arrhythmic recurrence. METHODS From a prospective AF ablation registry, 184 patients (mean age 59 ± 10 years, 65% male) who underwent first-time PV isolation using a smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA) were analyzed. Postablation transthoracic echocardiography (TTE) was performed within 1-3 days after ablation, and the occurrence of PE was assessed. RESULTS PE developed in 91 patients (49.5%), and most were of minimal severity (minimal, 93.4%; mild, 6.6%). Patients with PE had significantly lower body mass index and underwent cavotricuspid isthmus ablation more frequently. Early arrhythmic recurrence (EAR) (within 3 months) was observed in 28.8% of patients and was not different according to the PE development (PE [+]: 29.7% vs PE [-]: 28.0%; P = .80). During a median follow-up of 696 days, the cumulative rate of the late arrhythmic recurrence (LAR) (after 3 months) was 36.4%, and there was no difference between groups (PE [+]: 36.7% vs PE [-]: 35.1%; P = .988). The only predictor of LAR was EAR, and no echocardiographic parameters showed a significant correlation with LAR. CONCLUSIONS Minimal or mild PE after PVI for paroxysmal AF is a frequent echocardiographic finding, and it had no significant association with AF recurrence. Routine TTE after AF ablation has no clinical implication.
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Affiliation(s)
- Ungjeong Do
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Verlato R, Pieragnoli P, Iacopino S, Rauhe W, Molon G, Stabile G, Rebellato L, Allocca G, Arena G, Rovaris G, Sacchi R, Catanzariti D, Pepi P, Tondo C. Cryoballoon or radiofrequency ablation? Alternating technique for repeat procedures in patients with atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:687-697. [PMID: 32510595 DOI: 10.1111/pace.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Which technique is better for repeat ablation in patients with atrial fibrillation (AF) remains unclear. The aim of the study was to compare long-term efficacy of repeat ablation using the alternative technique for the first redo ablation procedure: (a) cryoballoon (CB) re-ablation after a failed index pulmonary vein isolation (PVI) with radiofrequency (RF) ablation, RF-then-CB group or (b) RF repeat ablation following a failed CB ablation, CB-then-RF group. METHODS Within the 1STOP Italian Project, consecutive patients undergoing repeat ablation with a different technique from the index procedure were included. RESULTS We studied 474 patients, 349 in RF-then-CB and 125 in CB-then-RF group. Less women (21% vs 30%; P = .041), more persistent AF (33% vs 22%; P = .015), longer duration of AF (60 vs 31 months; P < .001), and more hypertension (50% vs 36%; P = .007) were observed in the RF-then-CB cohort as compared with the CB-then-RF group. The number of reconnected PVs was 3.7 ± 0.7 and 1.4 + 1.3 in RF-then-CB and CB-then-RF group, respectively (P < .001). During the follow-up, significantly less AF recurrence occurred in the CB-then-RF group (22% vs 8%, HR = 0.46; 95% CI: 0.24-0.92; P = .025). Cohort designation was the only independent predictor of AF recurrence. CONCLUSION Alternation of energy source for repeat ablation was safe and effective, regardless the energy used first. However, patients initially treated with CB PVI undergoing repeat ablation with RF current had less AF recurrence at long-term follow-up as compared with those originally treated by RF ablation receiving a CB repeat ablation.
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Affiliation(s)
- Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | | | - Giuseppe Stabile
- Casa di Cura Montevergine, Mercogliano, Italy.,Clinica San Michele, Maddaloni, Italy
| | - Luca Rebellato
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Allocca
- Santa Maria dei Battuti, Presidio Ospedaliero, Conegliano, Italy
| | | | | | | | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan, Milan, Italy
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Transseptal Puncture Guided by Electroanatomic Mapping: A Novel Fluoroscopically and Echocardiographically Free Method. JACC Cardiovasc Interv 2020; 13:1233-1235. [PMID: 32438995 DOI: 10.1016/j.jcin.2020.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/24/2022]
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Fortuni F, Casula M, Sanzo A, Angelini F, Cornara S, Somaschini A, Mugnai G, Rordorf R, De Ferrari GM. Meta-Analysis Comparing Cryoballoon Versus Radiofrequency as First Ablation Procedure for Atrial Fibrillation. Am J Cardiol 2020; 125:1170-1179. [PMID: 32087997 DOI: 10.1016/j.amjcard.2020.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. Radiofrequency (RF) represents a standard of care for pulmonary vein isolation, whereas cryoballoon (CB) ablation has emerged as a valid alternative. The aim of our meta-analysis was to explore the efficacy and safety of CB compared with RF as first ablation procedure for AF. We searched the literature for studies that investigated this issue. The primary efficacy outcome was AF recurrence. The safety outcomes were: pericardial effusion, cardiac tamponade, phrenic nerve palsy, vascular complications, and major bleedings. Fourteen randomized controlled studies and 34 observational studies were included in the analysis. A total of 7,951 patients underwent CB ablation, whereas 9,641 received RF ablation. Mean follow-up was 14 ± 7 months. Overall, CB reduced the incidence of AF recurrence compared with RF ablation (relative risk [RR] 0.86; 95% confidence interval [CI] 0.78 to 0.94; p = 0.001), and this result was consistent across different study design and AF type. CB had a significantly higher rate of phrenic nerve palsy, whereas it was related to a lower incidence of pericardial effusion, cardiac tamponade (RR 0.58; 95% CI 0.38 to 0.88; p = 0.011) and vascular complications (RR 0.61; 95% CI 0.48 to 0.77; p <0.001) compared with RF. There was no significant difference in major bleedings between the 2 strategies. CB ablation had a shorter procedural time compared with RF (mean difference -20.76 minutes; p <0.001). In conclusion, considered its efficacy/safety profile and short procedural time, CB ablation represents the preferable option for first AF ablation procedure.
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Xiao FY, Ju WZ, Chen HW, Huang WJ, Chen M. A comparative study of pericardial effusion and pleural effusion after cryoballoon ablation or radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:1062-1067. [PMID: 32108393 DOI: 10.1111/jce.14423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The incidence and clinical outcome of pericardial and pleural effusion after cryoballoon ablation (CBA) or radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) have not been fully investigated. METHODS A total of 60 patients with paroxysmal AF were treated with either CBA (n = 30) or RFCA (n = 30) groups, with assessment of serum troponin I level, left atrial pulmonary vein computed tomography (CT) angiography and echocardiography within 24 hours before ablation, and serum troponin I level at 12 hours, and chest CT and echocardiography within 24 hours postablation. Repeat chest CT was performed 1 month after the index procedure in patients with pericardial or pleural effusion. RESULTS With similarly distributed baseline characteristics, the CBA group relative to the RFCA group had postablation: higher serum troponin I level (13.48 vs 1.84 µg/L, P < .001); similarly high pericardial effusion rates on chest CT (80% vs 93.3%, P > .05), with chest CT yielding significantly higher detection rate than echocardiography; similarly high pleural effusion rates on chest CT (73.3% vs 80%, P > .05); and smaller maximum depths on chest CT cross-section of pericardial effusion (5.21 ± 3.37 vs 7.13 ± 2.68 mm, P < .05) and pleural effusion bilaterally (left: 4.16 ± 4.90 vs 6.96 ± 5.42 mm; right: 5.04 ± 4.46 vs 7.55 ± 4.95 mm, both P < .05). The effusions self-resolved within a mean period of 1 month. CONCLUSIONS Both CBA and RFCA were associated with high rates of pericardial and pleural effusion, with RFCA yielding numerically higher incidence and significantly higher effusion extent, and chest CT significantly higher detection rates than echocardiography.
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Affiliation(s)
- Fang Yi Xiao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Jian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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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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12
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Patel N, Patel K, Shenoy A, Baker WL, Makaryus AN, El-Sherif N. Cryoballoon Ablation for the Treatment of Atrial Fibrillation: A Meta-analysis. Curr Cardiol Rev 2019; 15:230-238. [PMID: 30539701 PMCID: PMC6719384 DOI: 10.2174/1573403x15666181212102419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ablation therapy is the treatment of choice in antiarrhythmic drugrefractory atrial fibrillation (AF). It is performed by either cryoballoon ablation (CBA) or radiofrequency ablation. CBA is gaining popularity due to simplicity with similar efficacy and complication rate compared with RFA. In this meta-analysis, we compare the recurrence rate of AF and the complications from CBA versus RFA for the treatment of AF. METHODS We systematically searched PubMed for the articles that compared the outcome of interest. The primary outcome was to compare the recurrence rate of AF between CBA and RFA. We also included subgroup analysis with complications of pericardial effusion, phrenic nerve palsy and cerebral microemboli following ablation therapy. RESULTS A total of 24 studies with 3527 patients met our predefined inclusion criteria. Recurrence of AF after CBA or RFA was similar in both groups (RR: 0.84; 95% CI: 0.65, 1.07; I2=48%, Cochrane p=0.16). In subgroup analysis, heterogeneity was less in paroxysmal AF (I2=0%, Cochrane p=0.46) compared to mixed AF (I2=72%, Cochrane p=0.003). Procedure and fluoroscopy time was less by 26.37 and 5.94 minutes respectively in CBA compared to RFA. Complications, pericardial effusion, and silent cerebral microemboli, were not different between the two groups, however, phrenic nerve palsy was exclusively present only in CBA group. CONCLUSION This study confirms that the effectiveness of CBA is similar to RFA in the treatment of AF with the added advantages of shorter procedure and fluoroscopy times.
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Affiliation(s)
- Nirav Patel
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States
| | - Krunalkumar Patel
- Division of Cardiology, North Shore University Hospital, Manhasset, NY, United States
| | - Abhishek Shenoy
- Division of Medicine, University of Virginia, Charlottesville, VA, United States
| | - William L Baker
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States.,Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, United States
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, United States.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Nabil El-Sherif
- Division of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States
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13
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Ziffra JB, Germano ND, Phillips AN, Olshansky B. A Case of Postablation Pericardial Effusion. J Innov Card Rhythm Manag 2018; 9:3365-3368. [PMID: 32477786 PMCID: PMC7252661 DOI: 10.19102/icrm.2018.091002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/10/2018] [Indexed: 11/06/2022] Open
Abstract
Complications of atrial fibrillation ablation include pericardial effusion, which tends to occur acutely. Large and hemodynamically important effusions are uncommon, but a small effusion may be present at the end of the procedure in up to 22% of ablations. We monitor for pericardial effusions routinely after ablation with intracardiac echocardiography. However, the follow-up of a small effusion present immediately after ablation remains uncertain, especially with the use of dabigatran or another novel oral anticoagulant. There are no current recommendations on the follow-up of small pericardial effusions after ablation. We present a case and ask a panel of experts for their opinions.
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Affiliation(s)
- Jeffrey B Ziffra
- Department of Cardiology, Mercy Medical Center, Mason City, IA, USA
| | | | | | - Brian Olshansky
- Department of Cardiology, University of Iowa, Iowa City, IA, USA
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14
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Chang TY, Lo LW, Te ALD, Lin YJ, Chang SL, Hu YF, Chung FP, Chao TF, Liao JN, Tuan TC, Lin CY, Vicera JJ, Huang TC, Hoang MQ, Yamada S, Chen SA. The importance of extrapulmonary vein triggers and atypical atrial flutter in atrial fibrillation recurrence after cryoablation: Insights from repeat ablation procedures. J Cardiovasc Electrophysiol 2018; 30:16-24. [PMID: 30230088 DOI: 10.1111/jce.13741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION It has not been previously investigated whether the recurrence mechanism after cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (AF) is similar to that of radiofrequency catheter ablation (RFCA). We aimed to evaluate the differences of recurrence characteristics between RFCA and CBA after the index procedure. METHODS A total of 210 patients were enrolled in the study, and 69 patients underwent pulmonary vein (PV) isolation using a 28-mm second-generation CBA. The control group comprising 140 patients underwent PV isolation using an open-irrigated radiofrequency ablation catheter. A total of 69 patients in the CBA group and 69 patients in the RFCA group were investigated after propensity score matching. Recurrence patterns of AF were studied in the repeated procedure. RESULTS During the index procedure, there was no difference in PV or non-PV triggers between the two groups. Nineteen (27.5%) patients in the CBA group and 19 (27.5%) patients in the RFCA group had recurrence after a follow-up of 11.3 ± 7 months. The Kaplan-Meier curve did not reveal significant difference in recurrence (log-rank, P = 0.364) between the two groups. In the second procedure, the CBA group had more non-PV triggers (63.6%, P = 0.009) and left atrial (LA) flutters (54.5%, P = 0.027) compared with the RFCA group (12.5% and 12.5%, respectively). The PV reconnection rates were similar between both groups. CONCLUSIONS There was no difference in AF recurrence after catheter ablation between CBA and RFCA, but significant increases of non-PV triggers and LA flutter during the second procedure suggest the importance of the atrial substrate in maintaining AF during the second procedure after previous CBA.
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Affiliation(s)
- Ting-Yung Chang
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Abigail Louise D Te
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Jennifer Jeanne Vicera
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chun Huang
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Minh Quang Hoang
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, Heart Rhythm Center, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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15
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Mugnai G, de Asmundis C, Iacopino S, Ströker E, Longobardi M, Negro MC, De Regibus V, Coutino-Moreno HE, Takarada K, Choudhury R, de Torres JPA, Storti C, Brugada P, Chierchia GB. Acute pericarditis following second-generation cryoballoon ablation for atrial fibrillation. J Interv Card Electrophysiol 2018; 51:279-284. [PMID: 29445985 DOI: 10.1007/s10840-018-0329-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Acute pericarditis is a minor complication following atrial fibrillation (AF) ablation procedures. The aim of the study was to evaluate the incidence and clinical aspects of pericarditis following cryoballoon (CB) ablation of AF investigating a possible association with procedural characteristics and a possible relationship with post-ablation recurrences. METHODS Four hundred fifty consecutive patients (male 73%, age 59.9 ± 11.2 years) with drug-resistant paroxysmal AF who underwent CB ablation as index procedure were enrolled. Exclusion criteria were any contraindication for the procedure including the presence of intracavitary thrombus and uncontrolled heart failure and contraindications to general anesthesia. RESULTS Acute pericarditis following CB ablation occurred in 18 patients (4%) of our study population. Pericardial effusion occurred in 14 patients (78%) and was mild/moderate. The total number of cryoapplications and the total freeze duration were significantly higher in patients with pericarditis compared with those without (respectively, p = 0.0006 and p = 0.01). Specifically, the number of applications and freeze duration in right inferior pulmonary vein were found significantly higher in patients with pericarditis (p = 0.007). The recurrence rate did not significantly differ between the two study groups (respectively, 16.7 vs 18.1%; p = 0.9). CONCLUSIONS The incidence of acute pericarditis following CB ablation in our study population accounted for 4% and was associated with both total freezing time and number of cryoapplications. The clinical course was favorable in all these patients and the occurrence of acute pericarditis did not affect the outcome during the follow-up period.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium. .,Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy.
| | - Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Massimo Longobardi
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Maria Claudia Negro
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Valentina De Regibus
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.,Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Ken Takarada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Rajin Choudhury
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Cesare Storti
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
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16
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Fong HK, Abdullah O, Gautam S. Cough as the sole manifestation of pericardial effusion. BMJ Case Rep 2018; 2018:bcr-2017-222327. [PMID: 29437733 DOI: 10.1136/bcr-2017-222327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old woman with paroxysmal atrial fibrillation (AF) presented with severe non-productive cough, malaise, low-grade fever and AF flare-up 3 weeks following pulmonary vein isolation with radiofrequency catheter ablation. She denied chest pain or dyspnoea. Patient was haemodynamically stable. There was no pulsus paradoxus. Laboratories showed leucocytosis and elevated C-reactive protein. ECG showed sinus tachycardia. CT abdomen and pelvis showed a large pericardial effusion (PE). Shortly after admission, she developed AF with rapid ventricular response, responsive to intravenous amiodarone. Transthoracic echocardiogram revealed 2.4 cm posterior PE without tamponade physiology, non-amenable to pericardiocentesis via sub-xiphoid approach. Patient underwent left thoracoscopic pericardial window with removal of 250 cc bloody fibrinous fluid. Cough improved significantly and she was discharged on oral amiodarone and apixaban. Repeat CT chest after 2 weeks for recurrent cough showed a small PE, treated with oral prednisone for suspected postablation pericarditis, with complete resolution of cough. Amiodarone was stopped without recurrence of AF.
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Affiliation(s)
- Hee Kong Fong
- Department of Internal Medicine, University of Missouri Health Care, Columbia, Missouri, USA
| | - Obai Abdullah
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, Missouri, USA
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, Missouri, USA
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17
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Canpolat U, Kocyigit D, Aytemir K. Complications of Atrial Fibrillation Cryoablation. J Atr Fibrillation 2017; 10:1620. [PMID: 29487676 PMCID: PMC5821627 DOI: 10.4022/jafib.1620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Duygu Kocyigit
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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18
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Efficacy and safety of cryoballoon ablation versus radiofrequency catheter ablation in atrial fibrillation: an updated meta-analysis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:240-249. [PMID: 29056997 PMCID: PMC5644043 DOI: 10.5114/aic.2017.70196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Cryoballoon ablation (CBA) and irrigated radiofrequency catheter ablation (RFCA) are the main treatments for drug-refractory symptomatic atrial fibrillation (AF). Aim To compare the efficacy and safety between CBA and RFCA for the treatment of AF. Material and methods We searched the Embase and Medline databases for clinical studies published up to December 2016. Studies that satisfied our predefined inclusion criteria were included. Results After searching through the literature in the two major databases, 20 studies with a total of 9,141 patients were included in our study. The CBA had a significantly shorter procedure time (weighted mean difference (WMD) –30.38 min; 95% CI: –46.43 to –14.33, p = 0.0002) and non-significantly shorter fluoroscopy time (WMD –3.18 min; 95% CI: –6.43 to 0.07, p = 0.06) compared with RFCA. There was no difference in freedom from AF between CBA and RFCA (CBA 78.55% vs. RFCA 83.13%, OR = 1.15, 95% CI: 0.95–1.39, p = 0.14). The CBA was associated with a high risk of procedure-related complications (CBA 9.02% vs. RFCA 6.56%, OR = 1.56, 95% CI: 1.05–2.31, p = 0.03), especially phrenic nerve paralysis (PNP, OR = 10.72, 95% CI: 5.59–20.55, p < 0.00001). The risk of pericardial effusions/cardiac tamponade was low in the CBA group (CBA 1.05% vs. RFCA 1.86%, OR = 0.62, 95% CI: 0.41–0.93, p = 0.02). Conclusions For AF, CBA was as effective as RFCA. However, CBA had a shorter procedure time and a non-significantly shorter fluoroscopy time, a significantly high risk of PNP and a low incidence of pericardial effusions/cardiac tamponade compared with RFCA.
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19
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Shakkottai P, Sy RW, McGuire MA. Cryoablation for Atrial Fibrillation in 2017: What Have We Learned? Heart Lung Circ 2017; 26:950-959. [DOI: 10.1016/j.hlc.2017.05.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/02/2017] [Indexed: 01/25/2023]
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20
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Zhou X, Lv W, Zhang W, Ye Y, Li Y, Zhou Q, Zhang J, Xing Q, Lu Y, Zhang L, Wang H, Qin W, Tang B. Comparative efficacy and safety of contact force-sensing catheter and second-generation cryoballoon ablation for atrial fibrillation: a meta-analysis. ACTA ACUST UNITED AC 2017; 50:e6409. [PMID: 28793059 PMCID: PMC5572854 DOI: 10.1590/1414-431x20176409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/23/2017] [Indexed: 11/21/2022]
Abstract
This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84–40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=–4.48–5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37–1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03–0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78–1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.
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Affiliation(s)
- X Zhou
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Lv
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Ye
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Li
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Q Zhou
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - J Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Q Xing
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Lu
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - L Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - H Wang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Qin
- Xinjiang Medical University, Urumqi, Xinjiang, China
| | - B Tang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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21
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Chen CF, Gao XF, Duan X, Chen B, Liu XH, Xu YZ. Comparison of catheter ablation for paroxysmal atrial fibrillation between cryoballoon and radiofrequency: a meta-analysis. J Interv Card Electrophysiol 2017; 48:351-366. [DOI: 10.1007/s10840-016-0220-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
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22
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Kocyigit D, Canpolat U, Aytemir K. Who Needs Catheter Ablation And Which Approach? J Atr Fibrillation 2016; 8:1335. [PMID: 27957233 DOI: 10.4022/jafib.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
Abstract
Catheter ablation therapy for atrial fibrillation (AF) has gained a significant role during maintenance of sinus rhythm compared to anti-arrhythmic medication. Catheter ablation techniques are also improved and progressed over years in parallel to better understanding of disease mechanisms and technological advancements. However, due to invasive nature of the therapy with its pertinent procedural risks, both appropriate patient selection and use of relevant approach should be considered by all electrophysiologists before decide to perform catheter ablation.
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Affiliation(s)
- Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Management of Tamponade Complicating Catheter Ablation for Atrial Fibrillation: Early Removal of Pericardial Drains Is Safe and Effective and Reduces Analgesic Requirements and Hospital Stay Compared to Conventional Delayed Removal. JACC Clin Electrophysiol 2016; 3:367-373. [PMID: 29759449 DOI: 10.1016/j.jacep.2016.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study reports on the safety of early removal of pericardial drains after cardiac tamponade complicating atrial fibrillation catheter ablation (AFCA) procedures, the need for repeat pericardiocentesis, major adverse outcomes, as well as length of stay, and the need for opiate analgesia. BACKGROUND Tamponade from AFCA is traditionally managed by pericardiocentesis with delayed removal of the drain (typically 12 to 24 h later) in case of re-bleeding. A drain in situ often causes severe pain but ongoing blood loss is rare. Our institution adopted the practice of early removal of drains before leaving the laboratory if bleeding has stopped. METHODS The authors performed a retrospective descriptive analysis of 43 cases of tamponade complicating AFCA from 2006 to 2015, comparing patients in whom the drain was removed early (group early removal [ER]; n = 25) versus traditional delayed removal (group delayed removal [DR]; n = 18). RESULTS The groups were similar with respect to clinical/demographic characteristics, proportions of first-time versus re-do and pulmonary vein isolation versus pulmonary vein isolation + additional ablation. There were no deaths. No ER patients required drain re-insertion before discharge. The length of stay was shorter in the ER group (3 days; range 1 to 9 days) than in the DR group (4 days; range 2 to 60 days). The requirement for opiate analgesia was less in the ER group (8%) than in the DR group (72%). CONCLUSIONS Early removal of pericardial drains after tamponade complicating AFCA procedures appears to be safe and effective, with re-insertion not required in this cohort. The traditional practice of leaving drains in situ for 12 to 24 h may result in more patient discomfort and longer hospitalization.
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CARDOSO RHANDERSON, MENDIRICHAGA RODRIGO, FERNANDES GILSON, HEALY CHRIS, LAMBRAKOS LITSAK, VILES-GONZALEZ JUANF, GOLDBERGER JEFFREYJ, MITRANI RAULD. Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis. J Cardiovasc Electrophysiol 2016; 27:1151-1159. [DOI: 10.1111/jce.13047] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/15/2023]
Affiliation(s)
- RHANDERSON CARDOSO
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RODRIGO MENDIRICHAGA
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - GILSON FERNANDES
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - CHRIS HEALY
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - LITSA K. LAMBRAKOS
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JUAN F. VILES-GONZALEZ
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JEFFREY J. GOLDBERGER
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RAUL D. MITRANI
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
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Abed HS, Chen V, Kilborn MJ, Sy RW. Periprocedural Management of Novel Oral Anticoagulants During Atrial Fibrillation Ablation: Controversies and Review of the Current Evidence. Heart Lung Circ 2016; 25:1164-1176. [PMID: 27425183 DOI: 10.1016/j.hlc.2016.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 04/05/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Oral anticoagulation (OAC) has been the cornerstone for the prevention of thromboembolic complications in patients with atrial fibrillation (AF) at significant risk of stroke. Catheter ablation is an established efficacious technique for the treatment of AF. Ameliorating the risk of stroke or transient ischaemic attack (TIA) in patients with AF undergoing ablation requires meticulous planning of pharmacotherapy. The advent of non-vitamin K oral anticoagulants (NOACs) has broadened the therapeutic scope, representing a viable alternative to traditional vitamin K antagonists (VKA) in non-valvular AF. Potential advantages of NOACs include greater pharmacokinetic predictability, at least comparable efficacy as compared to VKA and a superior haemorrhagic complication profile. However, robust evidence for the safety and efficacy of periprocedural NOAC use for AF ablation remains uncertain with a non-uniform clinical approach between and within institutions. The following review will summarise the current and emerging evidence on periprocedural management of NOACs in patients undergoing catheter ablation of AF. An overview of NOAC pharmacology will provide a foundation for the review of reversal agents in the context of catheter ablation of AF. The purpose of the review is to outline key studies and identify key areas for further critical research with the ultimate aim of developing evidence-based guidelines for optimal care.
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Affiliation(s)
- Hany S Abed
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia
| | - Vivien Chen
- Department of Haematology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia
| | - Michael J Kilborn
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia.
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LIU XIAOHUA, CHEN CHAOFENG, GAO XIAOFEI, XU YIZHOU. Safety and Efficacy of Different Catheter Ablations for Atrial Fibrillation: A Systematic Review and Meta-Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:883-99. [PMID: 27197002 DOI: 10.1111/pace.12889] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 12/30/2022]
Affiliation(s)
- XIAO-HUA LIU
- Hangzhou Hospital of Zhejiang Chinese Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - CHAO-FENG CHEN
- Department of Cardiology; Hangzhou Hospital of Nanjing Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - XIAO-FEI GAO
- Hangzhou Hospital of Zhejiang Chinese Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - YI-ZHOU XU
- Department of Cardiology; Hangzhou Hospital of Nanjing Medical University; Shangcheng District Hangzhou City Zhejiang Province China
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Kabunga P, Phan K, Ha H, Sy RW. Meta-Analysis of Contemporary Atrial Fibrillation Ablation Strategies. JACC Clin Electrophysiol 2016; 2:377-390. [DOI: 10.1016/j.jacep.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/01/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022]
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Wissner E, Deiss S, Kuck KH. Balloon-based pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (cryoballoon and laserballoon). Future Cardiol 2015; 11:663-71. [PMID: 26610028 DOI: 10.2217/fca.15.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Electrical isolation of the pulmonary veins still remains one of the major objectives during catheter ablation of atrial fibrillation. In patients with paroxysmal atrial fibrillation, balloon-based technologies hold great promise to simplify the approach to successful pulmonary vein isolation. While the cryoballoon represents the only true 'single-shot' technology, the laserballoon allows real-time endoscopic visualization of the pulmonary vein antrum during energy delivery. Either technology aims at complete electrical isolation, requiring continuous transmural lesion sets encircling the pulmonary veins. Strategies to confirm and to improve upon the efficacy of pulmonary vein isolation are the key to acute and long-term clinical success and will be reviewed in this article.
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Affiliation(s)
- Erik Wissner
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Sebastian Deiss
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
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Mugnai G, Irfan G, de Asmundis C, Ciconte G, Saitoh Y, Hunuk B, Velagic V, Stroker E, Rossi P, Capulzini L, Brugada P, Chierchia GB. Complications in the setting of percutaneous atrial fibrillation ablation using radiofrequency and cryoballoon techniques: A single-center study in a large cohort of patients. Int J Cardiol 2015; 196:42-9. [DOI: 10.1016/j.ijcard.2015.05.145] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/15/2022]
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30
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Miller JM, Sukov RJ. Case 222: Pericardioesophageal Fistula after Cardiac Radiofrequency Ablation. Radiology 2015; 277:298-302. [DOI: 10.1148/radiol.2015131662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aryana A, Bowers MR, O'Neill PG. Outcomes Of Cryoballoon Ablation Of Atrial Fibrillation: A Comprehensive Review. J Atr Fibrillation 2015; 8:1231. [PMID: 27957187 DOI: 10.4022/jafib.1231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022]
Abstract
Over the last decade, cryoballoon ablation has emerged as an effective alternate strategy to point-by-point radiofrequency ablation for treatment of symptomatic atrial fibrillation. There are several reasons for this. First, the acute and long-term safety and efficacy associated with cryoablation appear comparable to that of radiofrequency ablation in patients with both paroxysmal and also persistent atrial fibrillation. Second, cryoablation offers certain advantages over conventional radiofrequency ablation including a gentler learning curve, shorter ablation and procedure times as well as lack of need for costly electroanatomical mapping technologies commonly utilized with radiofrequency ablation. Lastly, with the recent advent of the second-generation cryoballoon, the effectiveness of cryoablation has further improved dramatically. This comprehensive review examines the gradual evolution of the cryoablation tools as well as the rationale and data in support of the currently-available cryoballoon technologies for catheter ablation of atrial fibrillation.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
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BADHWAR NITISH, LAKKIREDDY DHANUNJAYA, KAWAMURA MITSUHARU, HAN FREDERICKT, IYER SIVARAMANK, MOYERS BRIANS, DEWLAND THOMASA, WOODS CHRIS, FERRELL RYAN, NATH JAYANT, EARNEST MATHEW, LEE RANDALLJ. Sequential Percutaneous LAA Ligation and Pulmonary Vein Isolation in Patients with Persistent AF: Initial Results of a Feasibility Study. J Cardiovasc Electrophysiol 2015; 26:608-14. [DOI: 10.1111/jce.12655] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- NITISH BADHWAR
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | | | - MITSUHARU KAWAMURA
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | | | - SIVARAMAN K. IYER
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | - BRIAN S. MOYERS
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | - THOMAS A. DEWLAND
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | - CHRIS WOODS
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
| | - RYAN FERRELL
- Division of Cardiology; University of Kansas Medical Center; Kansas City Kansas
| | - JAYANT NATH
- Division of Cardiology; University of Kansas Medical Center; Kansas City Kansas
| | - MATHEW EARNEST
- Division of Cardiology; University of Kansas Medical Center; Kansas City Kansas
| | - RANDALL J. LEE
- Section of Cardiac Electrophysiology; Division of Cardiology; University of California, San Francisco; San Francisco California
- Cardiovascular Research Institute at the University of California; San Francisco California
- Institute for Regeneration Medicine at the University of California; San Francisco California USA
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Quallich SG, Van Heel M, Iaizzo PA. Optimal contact forces to minimize cardiac perforations before, during, and/or after radiofrequency or cryothermal ablations. Heart Rhythm 2015; 12:291-6. [DOI: 10.1016/j.hrthm.2014.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Indexed: 10/24/2022]
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Bhat T, Baydoun H, Asti D, Rijal J, Teli S, Tantray M, Bhat H, Kowalski M. Major complications of cryoballoon catheter ablation for atrial fibrillation and their management. Expert Rev Cardiovasc Ther 2014; 12:1111-8. [PMID: 25115140 DOI: 10.1586/14779072.2014.925802] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Atrial fibrillation (AF) is the most common symptomatic and sustained cardiac arrhythmia. It affects approximately 2-3 million people in the USA alone with an increased incidence and prevalence worldwide. It is associated, in addition to worsening quality of life, with increased morbidity and mortality especially in poorly controlled AF, affecting mostly those older than 65 years of age. Radiofrequency ablation was found to be a good strategy for focal isolation of pulmonary veins triggering from the vulnerable atrial substrate but is a time-consuming procedure and carries the risk of multiple complications like tamponade which could be fatal, atrioesophageal fistula and local thrombus formation at the site of ablation. Cryoballoon ablation with pulmonary vein isolation has emerged in the past few years as a breakthrough novel technology for the treatment of drug-refractory AF. It is a relatively simple alternative for point-by-point radiofrequency ablation of paroxysmal AF and is associated with fewer incidences of fatal complications such as cardiac perforation. As experience with this new tool accumulates, the field faces new challenges in the form of rare compilations including gastroparesis, phrenic nerve palsy, atrioesophageal fistula, pulmonary vein stenosis, thromboembolism pericardial effusion, and tamponade.
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Affiliation(s)
- Tariq Bhat
- Division of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA
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Yorgun H, Aytemir K, Canpolat U, ahiner L, Kaya EB, Oto A. Additional benefit of cryoballoon-based atrial fibrillation ablation beyond pulmonary vein isolation: modification of ganglionated plexi. Europace 2014; 16:645-651. [PMID: 23954919 DOI: 10.1093/europace/eut240] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Xu J, Huang Y, Cai H, Qi Y, Jia N, Shen W, Lin J, Peng F, Niu W. Is cryoballoon ablation preferable to radiofrequency ablation for treatment of atrial fibrillation by pulmonary vein isolation? A meta-analysis. PLoS One 2014; 9:e90323. [PMID: 24587324 PMCID: PMC3938670 DOI: 10.1371/journal.pone.0090323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/29/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Currently radiofrequency and cryoballoon ablations are the two standard ablation systems used for catheter ablation of atrial fibrillation; however, there is no universal consensus on which ablation is the optimal choice. We therefore sought to undertake a meta-analysis with special emphases on comparing the efficacy and safety between cryoballoon and radiofrequency ablations by synthesizing published clinical trials. METHODS AND RESULTS Articles were identified by searching the MEDLINE and EMBASE databases before September 2013, by reviewing the bibliographies of eligible reports, and by consulting with experts in this field. Data were extracted independently and in duplicate. There were respectively 469 and 635 patients referred for cryoballoon and radiofrequency ablations from 14 qualified clinical trials. Overall analyses indicated that cryoballoon ablation significantly reduced fluoroscopic time and total procedure time by a weighted mean of 14.13 (95% confidence interval [95% CI]: 2.82 to 25.45; P = 0.014) minutes and 29.65 (95% CI: 8.54 to 50.77; P = 0.006) minutes compared with radiofrequency ablation, respectively, whereas ablation time in cryoballoon ablation was nonsignificantly elongated by a weighted mean of 11.66 (95% CI: -10.71 to 34.04; P = 0.307) minutes. Patients referred for cryoballoon ablation had a high yet nonsignificant success rate of catheter ablation compared with cryoballoon ablation (odds ratio; 95% CI; P: 1.34; 0.53 to 3.36; 0.538), and cryoballoon ablation was also found to be associated with the relatively low risk of having recurrent atrial fibrillation (0.75; 0.3 to 1.88; 0.538) and major complications (0.46; 0.11 to 1.83; 0.269). There was strong evidence of heterogeneity and low probability of publication bias. CONCLUSION Our findings demonstrate greater improvement in fluoroscopic time and total procedure duration for atrial fibrillation patients referred for cryoballoon ablation than those for radiofrequency ablation.
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Affiliation(s)
- Junxia Xu
- Department of Geratology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, Fujian, China
- Department of Geratology, Fozhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (FP); (JX); (WN)
| | - Yingqun Huang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hongbin Cai
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yue Qi
- Department of Epidemiology, Capital Medical University Affiliated Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Nan Jia
- Department of Cardiology, The Fourth People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Weifeng Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (FP); (JX); (WN)
| | - Wenquan Niu
- Department of Human Genetics and Biostatistics, Institute of Cardiovascular Disease, Dalian Medical University, Dalian, Liaoning, China
- Center for Evidence-Based Medicine, Institute of Cardiovascular Disease, Dalian Medical University, Dalian, Liaoning, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (FP); (JX); (WN)
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Martí-Almor J, Jauregui-Abularach ME, Benito B, Vallès E, Bazan V, Sánchez-Font A, Vollmer I, Altaba C, Guijo MA, Hervas M, Bruguera-Cortada J. Pulmonary Hemorrhage After Cryoballoon Ablation for Pulmonary Vein Isolation in the Treatment of Atrial Fibrillation. Chest 2014; 145:156-157. [DOI: 10.1378/chest.13-0761] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Aljaroudi WA, Saliba WS, Wazni OM, Jaber WA. Role of cardiac computed tomography and cardiovascular magnetic resonance imaging in guiding management and treatment of patients with atrial fibrillation: state of the art review. J Nucl Cardiol 2013; 20:426-42. [PMID: 23400559 DOI: 10.1007/s12350-013-9689-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with high morbidity and mortality. In view of an aging population, the prevalence and incidence of AF are on the rise and are expected to double in the coming decades, posing a huge economic burden on already strained resources. New innovative therapies such as pulmonary vein isolation and percutaneous closure of the left atrial appendage have emerged. The current applications of such therapies would not have been possible without the pivotal role of multimodality cardiovascular imaging. The role of echocardiography in guiding therapy has been extensively reviewed. However, there are new data in support of other complementary imaging modalities, mainly cardiac computed tomography and cardiovascular magnetic resonance imaging, which will be the focus of this review.
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Affiliation(s)
- Wael A Aljaroudi
- Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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39
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Bhave PD, Knight BP. Optimal Strategies Including Use of Newer Anticoagulants for Prevention of Stroke and Bleeding Complications Before, During, and After Catheter Ablation of Atrial Fibrillation and Atrial Flutter. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:450-66. [PMID: 23568665 DOI: 10.1007/s11936-013-0242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Prashant D Bhave
- Cardiology Division/Electrophysiology Section, Northwestern University Feinberg School of Medicine, 676 North St. Claire, Suite 600, Chicago, IL, 60611, USA,
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Filgueiras-Rama D, Merino JL. The Future of Pulmonary Vein Isolation - Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation? Arrhythm Electrophysiol Rev 2013; 2:59-64. [PMID: 26835042 DOI: 10.15420/aer.2013.2.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pulmonary vein isolation is the main goal of atrial fibrillation (AF) ablation to date. Lack of isolation is associated with an increased risk of AF recurrences. Precise navigation to specific target sites, catheter stability and appropriate contact force are requisites for effective radiofrequency applications. Conventional manual-guided point-by-point radiofrequency energy delivery shows limitations to reach them, especially when performed by non-experienced electrophysiologists. New technological alternatives are rapidly arising and becoming clinically available to overcome some of the manual-guided radiofrequency delivery shortcomings. Here, we review the most recent clinical data, potential advantages, shortcomings and future directions of the new ablation strategies for pulmonary vein isolation.
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Affiliation(s)
| | - Jose L Merino
- Head of the Robotic Cardiac Electrophysiology and Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia requiring treatment that is encountered in clinical practice. Recent advances in the understanding of underlying mechanisms of AF have led to the increased use of catheter ablation (CA) as a treatment modality for paroxysmal, persistent, or long-standing persistent AF in patients with symptomatic AF despite treatment with antiarrhythmic medications. Because of the complexity in technique and anatomic location of the ablation sites, it is not surprising that CA of AF is associated with a greater risk of procedural complications compared with simpler cardiac ablation procedures. Major and minor complications, including life-threatening complications, have been described and quantified. This systematic review describes the potential risks of CA that have been reported over a period and provides insights into the evolving strategies to minimize these complications, thus making CA techniques safer and potentially more efficacious for AF.
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Liu P, Ren S, Qian S, Wang F. Multiple cardiac perforations following radiofrequency catheter ablation: case report and literature reviews. Ann Thorac Cardiovasc Surg 2012; 18:370-4. [PMID: 22293306 DOI: 10.5761/atcs.cr.11.01730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Multiple cardiac ruptures after radiofrequency catheter ablation that requires surgical repair are uncommon. METHODS AND RESULTS We describe a 64-year old male patient with paroxysmal atrial fibrillation who had a cardiac tamponade following radiofrequency ablation. Surgical exploration demonstrated two ruptures in the left atrium, one in the right atrium, and one hematoma in the right atrium. MEDLINE, the Cochrane Library, and related databases were searched up to June 2011 without language restrictions, and related literature was reviewed and discussed. The patient has survived from prompt cardiac repair of cardiac ruptures and recovered from surgery without complications. CONCLUSIONS Urgent exploratory surgery with cardiopulmonary bypass is the key to salvage the patient.
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Affiliation(s)
- Peng Liu
- Cardiovascular Center, China-Japan Friendship Hospital, Beijing, China
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Lellouche N, Sebag FA, Elbaz N, Hassine M, Chaachoui N, Teiger E, Dubois-Randé JL, Lim P. Acute pericardial effusion following atrial fibrillation ablation: characteristics and relationship with arrhythmia recurrences. Arch Cardiovasc Dis 2011; 104:450-7. [PMID: 21944147 DOI: 10.1016/j.acvd.2011.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/12/2011] [Accepted: 05/13/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardial effusion (PE) can occur during or after atrial fibrillation (AF) ablation, and may induce atrial arrhythmia. AIM To characterize the impact of PE on arrhythmia recurrences following AF ablation. METHODS Patients referred for a first radiofrequency AF ablation were studied prospectively. Transthoracic echocardiography was performed before and 24h after the procedure. If PE was present, transthoracic echocardiography was repeated at 1 month to evaluate PE evolution. Early arrhythmia recurrences (EARs) were defined as any arrhythmia documented within 1 month of the procedure. RESULTS PE was diagnosed in 18/81 patients (22%); and was present in significantly more patients with persistent versus paroxysmal AF (14/40 [35%] vs 4/41 [10%]; P=0.008). PEs were mild (mean 6 ± 3mm), mainly asymptomatic (89%), and none required pericardiocentesis. Early and late arrhythmia recurrences were present in 25/81 (31%) and 29/81 (36%), respectively. The incidence of PE was significantly higher among patients with EARs versus those without (12/25 [48%] vs 6/56 [11%]; P=0.0004). By multivariable analysis, PE and duration in AF were the two independent predictors of EARs. PE incidence was similar in patients with and without late arrhythmia recurrences. At 1 month, no patients had PE on transthoracic echocardiography. CONCLUSION PE following radiofrequency AF ablation is frequent, particularly following persistent AF ablation. This effusion is generally mild, mainly asymptomatic, and independently associated with EARs.
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Cryoablation of atrial fibrillation. J Interv Card Electrophysiol 2011; 32:233-42. [DOI: 10.1007/s10840-011-9603-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
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Ozcan C, Ruskin J, Mansour M. Cryoballoon catheter ablation in atrial fibrillation. Cardiol Res Pract 2011; 2011:256347. [PMID: 21747987 PMCID: PMC3130969 DOI: 10.4061/2011/256347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/05/2011] [Accepted: 04/25/2011] [Indexed: 12/02/2022] Open
Abstract
Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.
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Affiliation(s)
- Cevher Ozcan
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
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Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 2011; 8:1444-51. [PMID: 21457789 DOI: 10.1016/j.hrthm.2011.03.050] [Citation(s) in RCA: 261] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 03/22/2011] [Indexed: 01/29/2023]
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Current World Literature. Curr Opin Cardiol 2011; 26:71-8. [DOI: 10.1097/hco.0b013e32834294db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anne W, Tavernier R, Duytschaever M. Four types of complications in paroxysmal atrial fibrillation ablation. Europace 2010; 12:303-4. [DOI: 10.1093/europace/euq036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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