This review highlights the importance of identifying high-risk patients and implementing best-practice techniques to minimize and manage rare but major complications of cryoballoon ablation for atrial fibrillation.
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Heightened awareness of CB ablation complications is warranted clinically; this Level 5 review leaves optimal prevention strategies open for prospective study.
Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is increasing every year. Patients who fail to maintain sinus rhythm with use of anti-arrhythmic drug therapy are referred for catheter ablation. Cryoballoon (CB) ablation has emerged as an effective and alternative treatment option to traditional point-by-point radiofrequency ablation, but there can be complications. This article reviews the incidence, presentation, risk factors, management and preventative strategies of three major complications associated with CB ablation: phrenic nerve injury, atrial oesophageal fistula and bronchial injury. Although these complications are rare, electrophysiologists should institute measures to identify high-risk patients, implement best-practice techniques to minimise risks and maintain a high index of suspicion to recognise the complications quickly and implement correct treatment strategies.
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Kulkarni et al. (2018) studied this question.
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