Left atrio-oesophageal fistula after atrial fibrillation ablation

2020 ◽  
Vol 13 (12) ◽  
pp. e232508
Author(s):  
Vishesh Paul ◽  
Rajamurugan Meenakshisundaram ◽  
Abdur R Jamal ◽  
Talha Bin Farooq
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Presentation ◽  
Surgical Repair ◽  
Posterior Wall ◽  
Cryoballoon Ablation ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Ablation Procedure ◽  
Atypical Chest Pain ◽  
Air Embolus

We report a case of a 68-year-old woman who presented with atypical chest pain and fluctuating neurological symptoms 4 weeks after cryoballoon ablation procedure for atrial fibrillation. Brain imaging showed multiple embolic infarcts, while the chest imaging revealed an abnormal connection between the posterior wall of the left atrium and the oesophagus. Based on her clinical presentation and the imaging findings, a diagnosis of left atrio-oesophageal fistula (AOF) was established. AOF carries a high mortality rate unless an urgent surgical repair is performed. Oesophageal instrumentation for an echocardiogram or endoscopy should be avoided as it can result in massive air embolus, causing stroke or death.

scholarly journals Recurrent and late-onset coronary spasms after cryoballoon ablation procedure in a patient with atrial fibrillation

2016 ◽  
Vol 2 (5) ◽  
pp. 421-424 ◽  
Author(s):  
Tomonori Watanabe ◽  
Hitoshi Hachiya ◽  
Shinsuke Miyazaki ◽  
Hiroaki Nakamura ◽  
Hiroshi Taniguchi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Late Onset ◽  
Cryoballoon Ablation ◽  
Ablation Procedure

scholarly journals Concomitant utilization of radiofrequency ablation during atrial fibrillation cryoballoon ablation procedures

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
RS Gaitonde ◽  
JA Martel ◽  
CP Porterfield ◽  
NS Koide ◽  
A Kobori ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Statistical Significance ◽  
Posterior Wall ◽  
Utilization Rate ◽  
Cryoballoon Ablation ◽  
Rf Ablation ◽  
Ablation Catheter ◽  
Additional Lesion ◽  
Number Of Patients ◽  
Reported Data

Abstract Funding Acknowledgements Type of funding sources: None. Background Use of cryoballoon ablation (CBA) for the treatment of atrial fibrillation (AF) has become increasingly common in recent years. While various techniques have been described for use of the cryoballoon to achieve PVI and create selective additional lesion sets, the need for concomitant radiofrequency (RF) ablation in delivering touch-up ablation or non-PVI lesion sets has not been quantified. Purpose To quantify the rate of RF ablation catheter use in AF CBA procedures, and to evaluate whether indication for ablation can be used as a predictor of the need for supplementary RF ablation. Methods Self-reported data was prospectively collected in AF CBA procedures. Procedural characteristics including concomitant utilization of RF ablation catheters and lesion set delivery were recorded and analyzed. Post-hoc statistical analysis was completed utilizing a two-sample t-test of significance. Results Data was collected in a total of 246 AF CBA cases across 44 centers in the USA, Europe, and Japan. Included in the analysis were 170 paroxysmal atrial fibrillation cases (PAF group); 70 PersAF and 6 LsPersAF cases (PersAF group). Utilization rates for RF ablation catheters did not differ between the two groups; 35.9% and 36.8% of cases in PAF and PersAF, respectively (p = 0.885). The number of patients in which non-PV lesion sets were delivered also did not differ between groups; 38.2% and 40.8% in PAF and PersAF, respectively (p = 0.706). The choice of non-PV lesion sets varied as shown in Table 1. Upon completion of ablation, more patients were in sinus rhythm in the PAF group compared to the PersAF group, but the difference did not reach statistical significance; 88.2% and 78.9%, respectively (p = 0.057). Conclusions RF ablation catheter utilization rates were similar between groups, suggesting that indication (PAF vs. PersAF) alone is not a good predictor of whether concomitant RF ablation catheter utilization will be required during an AF CBA procedure. Table 1 Incidence Lesion Set PAF (n = 170) PersAF (n = 76) CTI Line 26.5% (45/170) 15.8% (12/76) Isolation/Homogenization of Fibrotic Areas 2.9% (5/170) 3.9% (3/76) CFE 2.9% (5/170) 0.0% (0/76) Posterior Wall Isolation 1.8% (3/170) 21.1% (16/76) Roof Line 1.8% (3/170) 7.9% (6/76) Other 9.4% (16/170) 27.6% (21/76) Utilization rate of non-PVI lesion sets

scholarly journals Association between clinical characteristics and short-term outcomes in adult male COVID-19 patients with mild clinical symptoms: a single-center observational study

2020 ◽  
Author(s):  
Bailing Yan ◽  
Lei Song ◽  
Jia Guo ◽  
Yangyang Wang ◽  
Liping Peng ◽  
...  
Keyword(s):  
Observational Study ◽  
Adult Male ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Blood Oxygen ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Short Term ◽  
Blood Oxygen Saturation ◽  
Abnormal Chest

Abstract Background: Majority of patients with 2019 novel coronavirus infection (COVID-19) exhibit mild symptoms. Identification of COVID-19 patients with mild symptoms who might develop into severe or critical illness is essential to save lives.Materials and Methods: We conducted an observational study in a dedicated make-shift hospital for adult male COVID-19 patients with mild symptoms between February and March 2020. Baseline characteristics, medical history, and clinical presentation were recorded. Laboratory tests and chest computed tomography were performed. Patients were observed until they were either transferred to a hospital for advanced care owing to disease exacerbation or were discharged after improvement. Patients were grouped based on their chest imaging findings or short-term outcomes.Results: A total of 125 COVID-19 patients with mild symptoms were enrolled. Of these, 7 patients were transferred for advanced care while 118 patients were discharged after improvement and showed no disease recurrence during an additional 28-day follow-up period. Eighty-five patients (68.0%) had abnormal chest imaging findings. Patients with abnormal chest imaging findings were more likely to have disease deterioration and require advanced care as compared to those with normal chest imaging findings. Patients with deteriorated outcomes were more likely to have low peripheral blood oxygen saturation and moderately-elevated body temperature. There were no significant differences between patients with deteriorated or improved outcomes with respect to age, clinical presentation, or comorbidities.Conclusions: Abnormal chest imaging findings, low peripheral blood oxygen saturation, and elevated temperature were associated with disease deterioration in adult male COVID-19 patients with mild clinical symptoms. Trial registration: ClinicalTrials.gov ID: NCT04346602. Registered 12 April 2020- Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009RA3&selectaction=Edit&uid=U0003F4L&ts=2&cx=-ajpsbw

scholarly journals Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Florian Straube ◽  
Janis Pongratz ◽  
Alexander Kosmalla ◽  
Benedikt Brueck ◽  
Lukas Riess ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Phrenic Nerve Palsy ◽  
Dose Area Product ◽  
Af Ablation ◽  
Predictors Of Recurrence

Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.

scholarly journals CRYOABLATION IN ATRIAL FIBRILLATION: RATIONALE OF THE NATIONAL PROSPECTIVE REGISTRY AND PRELIMINARY RESULTS

2018 ◽  
pp. 21-25
Author(s):  
E. N. Mikhailov ◽  
T. A. Lyubimtseva ◽  
K. V. Davtyan ◽  
A. G. Topchian ◽  
E. S. Tarasyuk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Pulmonary Veins ◽  
National Study ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Safety And Efficacy ◽  
Informational System ◽  
Real Clinical Practice

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

scholarly journals Cryoballoon ablation of the left atrial posterior wall reduces recurrence of persistent atrial fibrillation in patients with non-paroxysmal atrial fibrillation

2021 ◽  
Author(s):  
Takatoshi Shigeta ◽  
Yasuteru Yamauchi ◽  
Yuichiro Sagawa ◽  
Atsuhito Oda ◽  
Shinichi Tachibana ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Conduction Block ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cryoballoon Ablation ◽  
Acute Success ◽  
Af Recurrence

Introduction: Detailed clinical outcomes of cryoballoon ablation of the left atrial (LA) posterior wall (LAPW) in patients with non-paroxysmal atrial fibrillation (AF) have not been fully examined. Methods: We analyzed the outcomes of 191 patients with non-paroxysmal AF, of whom 135 underwent cryoballoon ablation of the LAPW including the LA roof in addition to pulmonary vein isolation with a cryoballoon. Results: Complete conduction block at the LA roof was obtained in 97.0% (131/135) of patients and LAPW was isolated in 85.2% (115/135) of patients. Over 372 days (range, 182–450 days) of follow-up, atrial arrhythmia recurrence was observed in 55 (40.7%) patients, and atrial tachycardia (AT) recurrence accounted for 25.5% of cases. The prevalence of LA roof cryoballoon ablation tended to be higher in patients without recurrence than those with (74.3% vs. 61.8%, respectively; p=0.11), especially those with persistent AF recurrence (74.5% vs. 46.2%, p=0.01). Multivariate analysis revealed that cryoballoon ablation of the LA roof was a predictor of freedom from persistent AF recurrence and that it was not associated with AT recurrence. Durable LA roof lesions were confirmed in 18 (72.0%) of 25 patients who underwent redo ablation. Conclusion: Cryoballoon ablation of the LAPW leads to a sufficient acute success rate of complete conduction block and durable lesions of the LA roof without increasing the risk of AT recurrence. The prevalence of persistent AF recurrence decreases after additional cryoballoon ablation of the LAPW in patients with non-paroxysmal AF.

scholarly journals Cryoballoon Catheter Ablation in Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Cevher Ozcan ◽  
Jeremy Ruskin ◽  
Moussa Mansour
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Thrombus Formation ◽  
Persistent Atrial Fibrillation ◽  
Technical Aspect ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Tissue Integrity ◽  
Cryothermal Energy ◽  
Antiarrhythmic Medications

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.

scholarly journals Longstanding Persistent Atrial Fibrillation Ablation: How Do You Perform It?

2020 ◽  
Vol 33 (2) ◽  
pp. 89-95
Author(s):  
Carola Gianni ◽  
Andrea Natale ◽  
Amin Al-Ahmad
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Ablation Procedure ◽  
First Time

Longstanding-persistent atrial fibrillation is one of the most challenging arrhythmias to treat. While radiofrequency catheter ablation is highly effective in paroxysmal atrial fibrillation, pulmonary vein antral isolation (including posterior wall isolation) alone is not enough for nonparoxysmal atrial fibrillation, other targets should be sought in this population. In this case report, we will describe our approach in a typical patient presenting for a first-time ablation procedure for longstanding persistent atrial fibrillation.

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