Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation–An underappreciated frequent cause of incomplete isolation

• Published in: Pacing and clinical electrophysiology Vol. 47; no. 3; pp. 347 - 352
• Main Authors: Liao, Yu, Tomaiko‐Clark, Emrie D., Martinez, Jake, Shinoda, Yasutoshi, Morris, Michael F., Liu, Zhao, Shatz, Dalise Yi, Katrapati, Praneeth, Sahara, Naohiko, Weiss, J. Peter, Zawaneh, Michael S., Tung, Roderick, Bai, Rong, Su, Wilber
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2024
• Subjects: Ablation; atrial fibrillation; Atrial Fibrillation - surgery; Balloons; Catheter Ablation - methods; cryoballoon; Cryosurgery - methods; Echocardiography; expansion dislodgement; Freezing; Humans; Incidence; Occlusion; pulmonary vein; Pulmonary Veins - surgery; Treatment Outcome; pulmonary vein; atrial fibrillation; expansion dislodgement; occlusion; ablation; cryoballoon
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14910

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.