Thromboembolic Risks of the Procedural Process in Second-Generation Cryoballoon Ablation Procedures

• DOI: 10.1161/circep.117.005612
• Publication Date: 2017-12-15T20:10:48Z
• Authors: Shinsuke Miyazaki; Tomonori Watanabe; Takatsugu Kajiyama; Jin Iwasawa; Sadamitsu Ichijo; Hiroaki Nakamura; Hiroshi Taniguchi; Kenzo Hirao; Yoshito Iesaka
• Keywords: Male; Ultrasonography, Doppler, Transcranial; Middle Aged; Cryosurgery; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Intracranial Embolism; Pulmonary Veins; Risk Factors; Fluoroscopy; Atrial Fibrillation; Catheter Ablation; Humans; Female

Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or lesions. We investigated which procedural processes during cryoballoon procedures carried a risk.Forty paroxysmal atrial patients underwent pulmonary vein isolation using second-generation cryoballoons single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 (85.0%). Of 158 veins, 152 (96.2%) isolated cryoablation, 6 required touch-up radiofrequency ablation. A mean 5.0±1.2 applications applied, the left dwell time 76.7±22.4 minutes. The total MES counts/procedures 522 (426-626). Left access Flexcath sheath insertion generated 25 (11-44) (24-53) MESs. Using for transseptal increased count punctures. During cryoapplications, counts greatest first (117 [81-157]), especially after stretch/deflations (43 [21-81]). Pre- post-pulmonary potential mapping Lasso catheters 57 (21-88) 61 (36-88) Reinsertion once withdrawn subsequent produced 205 (156-310) Touch-up 32 (19-62) MESs, whereas electric cardioversion no SCEs lesions detected 11 (32.3%) 4 (11.7%) patients, respectively. older than those without; however, there significant factors SCEs.A number MESs SCE/silent lesion occurrences observed recorded variety steps procedure; majority occurred phases high probability gaseous emboli.