Anatomical and Procedural Factors of Severe Pulmonary Vein Stenosis After Cryoballoon Pulmonary Vein Ablation
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Author + information
- Kenichi Tokutake, MD,
- Michifumi Tokuda, MD, PhD,
- Seigo Yamashita, MD, PhD,
- Hidenori Sato, MD,
- Hirotsugu Ikewaki, MD,
- Eri Okajima, MD,
- Hirotsuna Oseto, MD,
- Masaaki Yokoyama, MD,
- Ryota Isogai, MD,
- Kenichi Yokoyama, MD,
- Mika Kato, MD, PhD,
- Ryohsuke Narui, MD, PhD,
- Shinichi Tanigawa, MD,
- Seiichiro Matsuo, MD, PhD,
- Satoru Miyanaga, MD, PhD,
- Kenichi Sugimoto, MD, PhD,
- Michihiro Yoshimura, MD, PhD and
- Teiichi Yamane, MD, PhD∗ (yamanet1{at}aol.com)
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Teiichi Yamane, Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Central Illustration
Abstract
Objectives This study examined the anatomical or procedural factors associated with severe pulmonary vein (PV) stenosis after cryoballoon PV isolation.
Background PV stenosis is a complication associated with cryoballoon ablation.
Methods The study included 170 consecutive patients with paroxysmal atrial fibrillation who underwent cryoballoon ablation. In addition to factors generally considered to be related to the occurrence of PV stenosis (PV size, cryoballoon application number and time, and minimum freezing temperature), we evaluated the following 4 factors: 1) depth of balloon position; 2) the PV angle (internal angle between each PV and horizontal line); 3) noncoaxial balloon placement (hemispherical occlusion); and 4) contact surface area between the cryoballoon and the PV wall (defined as the balloon contact ratio).
Results Severe PV stenosis (≥75% area reduction) was observed in 9 (1.3%) PVs (6 left superior and 3 right superior PVs) in 9 patients. The PV size, cryoballoon application number and time, minimum freezing temperature, and the depth of cryoballoon position were not significantly associated with occurrence of severe PV stenosis, but the PV angle was significantly smaller in PVs with severe stenosis than it was in those without stenosis (25.6 ± 9.7° vs. 34.2 ± 6.4°; p < 0.001). Hemispherical occlusion was more frequently observed and balloon contact ratio was larger in PVs with severe stenosis (55.6% vs. 14.8%; p = 0.049) than in those without stenosis (0.70 ± 0.06 vs. 0.54 ± 0.08; p < 0.001).
Conclusions A horizontally connecting PV, noncoaxial placement of cryoballoon, and a larger contact surface area of the cryoballoon were predictors of the occurrence of severe PV stenosis after cryoballoon ablation.
Footnotes
Dr. Narui was supported by a scholarship from the Japanese Heart Rhythm Society. Dr. Tokuda has received consulting honoraria from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 23, 2019.
- Revision received July 30, 2019.
- Accepted August 1, 2019.
- 2019 American College of Cardiology Foundation
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