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Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation

BACKGROUND: Cryoballoon pulmonary vein isolation (PVI) has emerged as an alternative to radiofrequency PVI for atrial fibrillation (AF). Data are lacking to define the rates and predictors of complications, particularly phrenic nerve injury (PNI). METHODS AND RESULTS: We evaluated a single‐center pr...

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Autores principales: Guhl, Emily N., Siddoway, Donald, Adelstein, Evan, Bazaz, Raveen, Mendenhall, George S., Nemec, Jan, Saba, Samir, Schwartzman, David, Voigt, Andrew, Wang, Norman C., Jain, Sandeep K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015404/
https://www.ncbi.nlm.nih.gov/pubmed/27444510
http://dx.doi.org/10.1161/JAHA.116.003724
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author Guhl, Emily N.
Siddoway, Donald
Adelstein, Evan
Bazaz, Raveen
Mendenhall, George S.
Nemec, Jan
Saba, Samir
Schwartzman, David
Voigt, Andrew
Wang, Norman C.
Jain, Sandeep K.
author_facet Guhl, Emily N.
Siddoway, Donald
Adelstein, Evan
Bazaz, Raveen
Mendenhall, George S.
Nemec, Jan
Saba, Samir
Schwartzman, David
Voigt, Andrew
Wang, Norman C.
Jain, Sandeep K.
author_sort Guhl, Emily N.
collection PubMed
description BACKGROUND: Cryoballoon pulmonary vein isolation (PVI) has emerged as an alternative to radiofrequency PVI for atrial fibrillation (AF). Data are lacking to define the rates and predictors of complications, particularly phrenic nerve injury (PNI). METHODS AND RESULTS: We evaluated a single‐center prospective registry of 450 consecutive patients undergoing cryoballoon PVI between 2011 and 2015. Patients were 59±10 years old, 26% were women, 58% had hypertension, their mean CHA (2) DS (2) VASc score was 1.7±1.3, 30% had persistent atrial fibrillation, and 92% received a second‐generation 28‐mm balloon. Predefined major complications were persistent PNI, pericardial effusion, deep vein thrombosis, arteriovenous fistula, atrioesophageal fistula, bleeding requiring transfusion, stroke, and death. PNI was categorized as persistent if it persisted after discharge from the laboratory. Logistic regression was performed to identify predictors of complications and specifically PNI. We identified a major complication in 10 (2.2%) patients. In 49 (10.8%) patients, at least transient PNI was observed; only 5 persisted beyond the procedure (1.1%). All cases of PNI resolved eventually, with the longest time to resolution being 48 days. We also describe 2 cases of PNI manifesting after the index hospitalization. Regression analysis identified 23‐mm balloon use (16.3% versus 5.2%, odds ratio 2.94, P=0.011) and increased age (62.8±7.7 versus 58.7±0.12 years, odds ratio 1.058, P=0.014) as independent significant predictors of PNI. There were no significant predictors of major complications. CONCLUSIONS: In a large contemporary cohort, cryoballoon PVI is associated with low procedural risk, including lower rates of PNI than previously reported. Older age and 23‐mm balloon use were associated with PNI. Our low rate of PNI may reflect more sensitive detection methods, including compound motor action potential monitoring and forced double‐deflation.
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spelling pubmed-50154042016-09-19 Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation Guhl, Emily N. Siddoway, Donald Adelstein, Evan Bazaz, Raveen Mendenhall, George S. Nemec, Jan Saba, Samir Schwartzman, David Voigt, Andrew Wang, Norman C. Jain, Sandeep K. J Am Heart Assoc Original Research BACKGROUND: Cryoballoon pulmonary vein isolation (PVI) has emerged as an alternative to radiofrequency PVI for atrial fibrillation (AF). Data are lacking to define the rates and predictors of complications, particularly phrenic nerve injury (PNI). METHODS AND RESULTS: We evaluated a single‐center prospective registry of 450 consecutive patients undergoing cryoballoon PVI between 2011 and 2015. Patients were 59±10 years old, 26% were women, 58% had hypertension, their mean CHA (2) DS (2) VASc score was 1.7±1.3, 30% had persistent atrial fibrillation, and 92% received a second‐generation 28‐mm balloon. Predefined major complications were persistent PNI, pericardial effusion, deep vein thrombosis, arteriovenous fistula, atrioesophageal fistula, bleeding requiring transfusion, stroke, and death. PNI was categorized as persistent if it persisted after discharge from the laboratory. Logistic regression was performed to identify predictors of complications and specifically PNI. We identified a major complication in 10 (2.2%) patients. In 49 (10.8%) patients, at least transient PNI was observed; only 5 persisted beyond the procedure (1.1%). All cases of PNI resolved eventually, with the longest time to resolution being 48 days. We also describe 2 cases of PNI manifesting after the index hospitalization. Regression analysis identified 23‐mm balloon use (16.3% versus 5.2%, odds ratio 2.94, P=0.011) and increased age (62.8±7.7 versus 58.7±0.12 years, odds ratio 1.058, P=0.014) as independent significant predictors of PNI. There were no significant predictors of major complications. CONCLUSIONS: In a large contemporary cohort, cryoballoon PVI is associated with low procedural risk, including lower rates of PNI than previously reported. Older age and 23‐mm balloon use were associated with PNI. Our low rate of PNI may reflect more sensitive detection methods, including compound motor action potential monitoring and forced double‐deflation. John Wiley and Sons Inc. 2016-07-21 /pmc/articles/PMC5015404/ /pubmed/27444510 http://dx.doi.org/10.1161/JAHA.116.003724 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Guhl, Emily N.
Siddoway, Donald
Adelstein, Evan
Bazaz, Raveen
Mendenhall, George S.
Nemec, Jan
Saba, Samir
Schwartzman, David
Voigt, Andrew
Wang, Norman C.
Jain, Sandeep K.
Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title_full Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title_fullStr Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title_full_unstemmed Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title_short Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
title_sort incidence and predictors of complications during cryoballoon pulmonary vein isolation for atrial fibrillation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015404/
https://www.ncbi.nlm.nih.gov/pubmed/27444510
http://dx.doi.org/10.1161/JAHA.116.003724
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