scholarly journals Cryoballoon Ablation for the Treatment of Atrial Fibrillation: A Meta-analysis

2019 ◽  
Vol 15 (3) ◽  
pp. 230-238 ◽  
Author(s):  
Nirav Patel ◽  
Krunalkumar Patel ◽  
Abhishek Shenoy ◽  
William L. Baker ◽  
Amgad N. Makaryus ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pericardial Effusion ◽  
Recurrence Rate ◽  
Subgroup Analysis ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Meta Analysis ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy ◽  
Ablation Therapy

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.

scholarly journals Cryoballoon ablation of atrial fibrillation in low and medium volume hospitals – experiences of the German REGIONAL registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Michaelsen ◽  
U Parade ◽  
H Bauerle ◽  
K.-D Winter ◽  
U Rauschenbach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pericardial Effusion ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Annual Number ◽  
Hospital Death ◽  
Cryoballoon Ablation ◽  
Community Hospitals ◽  
Phrenic Nerve Palsy ◽  
The Mean

Abstract Background Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established and widespread procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at low and medium volume hospitals is unknown. Aim To determine safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. Methods This registry study prospectively included 1004 consecutive patients who underwent PVI with CBA for symptomatic paroxysmal (n=563) or persistent AF (n=441) between 01/2019 and 09/2020 at 20 community hospitals (each performing <100 PVI/year). Qualifying criteria for participating hospitals were an experience of performing CBA for at least 1 year and a minimum of 50 CBA performed up to the start of the registry. All CBA procedures were performed according to the individual local standards of each hospital. Procedural data, acute efficacy and complications were determined. Results The mean annual number of CBA procedures performed was 59±26/hospital, the mean annual number of PVI performed regardless of the method used was 70±26/center. 8/20 hospitals performed CBA only. There were 22 operators (1,1/center), in 12/20 hospitals CBA was performed by an operator being board certified in invasive electrophysiology. 10/20 hospitals included <60 patients/center (n=381), the centers enrolling >60 patients/hospital included a total of 623 pts (62%). Mean procedure time was 90.1±31.6 min, mean fluoroscopy time was 19.2±11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients. Not achieving the goal of “all veins isolated” in a respective patient was mainly due to early termination of CBA procedure due to phrenic nerve palsy. Major complications occurred in 1,2% of patients: no in-hospital death (0%), clinical stroke in 2 patients (0.2%), pericardial effusion requiring pericardial drainage in 2 patients (0,2%), vascular complications needing vascular surgery and/or blood transfusion in 2 patients (0,2%), phrenic nerve palsy persisting up to hospital discharge in 6 patients (0,6%). Minor complications occurred in 7,5% of patients: pericardial effusion with no need of intervention in 0,4%, access site complications with no need for therapeutic intervention or prolonged in-hospital stay in 2,1% (mainly superficial hematoma) and phrenic nerve palsy resolving before discharge in 4,2%. No significant difference in the number of complications could be found when testing for numbers of enrolled patients (> or < than 60/hospital) or regarding the board certification status of the operator. Conclusions PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates despite low and moderate annual procedure numbers. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Safety and efficacy of cryoballoon-ablation for atrial fibrillation performed at local hospitals: results of the german register on cryoballoon-ablation in local hospitals (REGIONAL)

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Michaelsen ◽  
U Parade ◽  
H Bauerle ◽  
K-D Winter ◽  
U Rauschenbach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Pulmonary Veins ◽  
Hospital Death ◽  
Cryoballoon Ablation ◽  
Complication Rates ◽  
Community Hospitals ◽  
Phrenic Nerve Palsy ◽  
Safety And Efficacy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf REGIONAL Background Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at community hospitals with low to moderate case numbers is unknown. Aim To determine safety and efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. Methods 1004 PVI performed consecutively between 01/2019 and 09/2020 at 20 community hospitals (each <100 PVI using CBA/year) for symptomatic paroxysmal AF (n = 563) or persistentAF (n= 441) were included in this registry. CBA was performed considering local standards. Procedural data, efficacy and complications were determined. Results Mean number of PVI using CBA/year was 59 ± 26. Mean procedure time was 90.1 ± 31.6 min and mean fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients, early termination of CBA due to phrenic nerve palsy was the most frequent reason for incomplete isolation. There was no in-hospital death. 2 patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in 6 patients (0.6%), 2 of them (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), in 2 of these patients (0.2%) vascular surgery was required. In 48 patients (4.8 %) phrenic nerve palsy was noticed which persisted up to hospital discharge in 6 patients (0.6%). Conclusions PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high efficacy and low complication rates despite low to moderate annual procedure numbers.

scholarly journals A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Schaerli ◽  
S Knecht ◽  
F Spies ◽  
A Madaffari ◽  
S Osswald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy ◽  
Phrenic Nerve Injury ◽  
Surface Ecg ◽  
The Mean ◽  
The Right

Abstract Background Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP. Purpose This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP. Methods In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins ([email protected] ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by >25% in three consecutive beats or if the diaphragmatic contraction decreased. Results Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later. Conclusion Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation. aVF signal before and during ablation Funding Acknowledgement Type of funding source: None

scholarly journals P1714Clinical implications for patients with persistent phrenic nerve palsy after cryoballoon ablation of pulmonary veins

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii370-iii370
Author(s):  
T. Kleemann ◽  
K. Kouraki ◽  
M. Strauss ◽  
K. Schmidt ◽  
N. Werner ◽  
...  
Keyword(s):  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy

Cryoablation – how to avoid complications?

2019 ◽  
Vol 2 (51) ◽  
pp. 8-12
Author(s):  
Michał M. Farkowski
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Phrenic Nerve Palsy ◽  
Strict Adherence ◽  
Safety Procedures ◽  
Similar Risk

Cryoballon ablation (CB) of atrial fibrillation represents similar risk but slightly different profile of complications to radiofrequency ablation. Phrenic nerve palsy is the typical complication of CB which can be avoided in most cases by a strict adherence to a couple of simple safety procedures. The article presents review of complications related to CB as well as practical suggestions how to avoid most of them.

scholarly journals Novel Electromyographic Monitoring Technique for Prevention of Right Phrenic Nerve Palsy During Cryoballoon Ablation

2013 ◽  
Vol 6 (6) ◽  
pp. 1109-1114 ◽  
Author(s):  
Frédéric Franceschi ◽  
Linda Koutbi ◽  
Julien Mancini ◽  
Shahram Attarian ◽  
Sébastien Prevôt ◽  
...  
Keyword(s):  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy ◽  
Monitoring Technique
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