Key result
Laryngeal mask with mechanical ventilation linked to 0% symptomatic air embolism vs ASV during ablation.
Why the study?
Coronary air embolism is a rare, potentially fatal AF ablation complication facilitated by negative intrathoracic pressure under deep sedation, prompting evaluation of whether laryngeal mask positive-pressure ventilation reduces air embolism compared with adaptive servo-ventilation during cryoballoon ablation.
Does laryngeal mask with mechanical ventilation reduce coronary or cerebral air embolism in patients undergoing cryoballoon ablation for atrial fibrillation compared to adaptive servo-ventilation?
Observational (n=491)
No
Does laryngeal mask with mechanical ventilation reduce coronary or cerebral air embolism in patients undergoing cryoballoon ablation for atrial fibrillation compared to adaptive servo-ventilation?
Airway management with a laryngeal mask and mechanical ventilation significantly reduces the risk of coronary air embolism during cryoballoon ablation for atrial fibrillation compared to adaptive servo-ventilation.
Answers are grounded in this paper and cite their sources.
LM use was associated with fewer air embolisms than ASV; hypothesis-generating and requires randomized confirmation before practice change.
Background Coronary air embolism is a rare but potentially fatal complication during atrial fibrillation (AF) ablation, particularly when large-bore sheaths are used. Respiratory instability and negative intrathoracic pressure under deep sedation may facilitate air intrusion. This study evaluated whether airway management using a laryngeal mask (LM) with positive-pressure ventilation could reduce air embolism compared with adaptive servo-ventilation (ASV) during cryoballoon ablation (CBA). Methods We retrospectively analyzed consecutive patients who underwent CBA for AF at our University Hospital between January 2017 and June 2024. Patients were categorized according to respiratory management: ASV (n = 266) or LM with mechanical ventilation (n = 225). Baseline characteristics, procedural details, and complication rates were compared. The primary endpoint was the incidence of coronary or cerebral air embolism; secondary endpoints included all peri-procedural complications within 30 days. Results Among 491 patients (median age 68 years, 71.3% male), baseline clinical variables were generally comparable between groups except for AF type and left ventricular ejection fraction. Symptomatic coronary air embolism occurred in 5 patients (1.9%) in the ASV group and in none of the LM group (p = 0.0387). No cerebral embolism or deaths occurred. Other complications included two cases of cardiac tamponade (ASV) and two transient phrenic nerve palsies (LM) without significant differences. Positive-pressure ventilation using LM effectively prevented negative intrathoracic pressure and possible air intrusion through large-bore sheaths. Conclusion Airway management with a laryngeal mask and mechanical ventilation markedly reduced coronary air embolism during CBA compared with ASV. These results emphasize that respiratory control is a crucial determinant of procedural safety in large-bore sheath–based ablation techniques and support the wider use of LM ventilation for high-risk patients.
No takes yet. Share an insight, caveat, or question.
Fukaya et al. (2026) conducted an observational in Atrial fibrillation (n=491). Laryngeal mask with mechanical ventilation vs. Adaptive servo-ventilation (ASV) was evaluated on Incidence of coronary or cerebral air embolism (p=0.0387). Laryngeal mask with mechanical ventilation eliminated symptomatic coronary air embolism compared with adaptive servo-ventilation during cryoballoon ablation (0% vs 1.9%, p=0.0387).
Synapse has enriched 10 related papers. Consider them for comparative context: