Affiliation:
1. Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
Abstract
Background
Cryoballoon‐based pulmonary vein isolation (CB‐
PVI
) has been widely used for the treatment of atrial fibrillation. Although generally safe and effective, the procedure may be associated with pulmonary vein (
PV
) stenosis and bronchial or esophageal injury. The mechanisms leading to these complications have not been studied in detail. Our aim was to examine acute effects of cryoballoon on the pulmonary vessel and right heart pressures as well as
PV
wall morphology.
Methods and Results
In 8 patients (5 men, mean age 55±14 years) undergoing
CB
‐
PVI
, pressure in each
PV
was measured by catheter located inside the
PV
directly before and after
CB
‐
PVI
. The right atrial, right ventricular, and pulmonary artery pressures as well as pulmonary arterial wedge capillary pressure in the pulmonary artery branch corresponding to target
PV
were also measured. Morphological changes in
PVs
were assessed using intravascular ultrasonography.
There were no significant differences in
PV
pressures before and after ablation. The pulmonary arterial wedge capillary pressure significantly increased during cryoapplication (left superior: 20±10 versus 29±8.5 mm Hg,
P
=0.004; left inferior: 24±10 versus 32±6 mm Hg,
P
=0.012; right superior: 25±9 versus 35±10 mm Hg,
P
=0.002; right inferior: 24±10 versus 37±12 mm Hg,
P
=0.0036). The right atrial and pulmonary artery pressures increased significantly after
CB
‐
PVI
(9±6 versus 13±8 mm Hg,
P
=0.004, and 20±9 versus 24±10 mm Hg,
P
=0.048, respectively). Intravascular ultrasonography showed acute edema and dissection‐like changes causing relative lumen narrowing in 90% of
PVs
.
Conclusions
CB
‐
PVI
causes significant rise in pulmonary artery and right atrial pressures as well as
PV
wall damage. The clinical significance of these findings warrants further investigations.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
10 articles.
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