Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation-an underappreciated frequent cause of incomplete isolation

Yu Liao, Emrie D. Tomaiko-Clark, Jake Martinez, Yasutoshi Shinoda, Michael F. Morris, Zhao Liu, Dalise Yi Shatz, Praneeth Katrapati, Naohiko Sahara, J. Peter Weiss, Michael S. Zawaneh, Roderick Tung, Rong Bai, Wilber Su

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI). Methods: Primary cryoablation of AF was performed in 15 patients. PV occlusion status pre- and post-freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging-based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon. Results: A total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri-balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications. Conclusion: Incidence of expansion dislodgement of the cryoballoon was detected in one-fourth to one-third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - 2023

Keywords

  • ablation
  • atrial fibrillation
  • cryoballoon
  • expansion dislodgement
  • occlusion
  • pulmonary vein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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