Background
Asymptomatic cerebral embolism (ACE) is sometimes detected after cryoballoon ablation
of atrial fibrillation. The removal of air bubbles from the cryoballoon before utilization
may reduce the rate of ACE.
Objective
This study aims to compare the incidence of ACE between a conventional and a novel
balloon massaging method during cryoballoon ablation.
Methods
Of 175 consecutive patients undergoing initial cryoballoon ablation of paroxysmal
atrial fibrillation, 60 (34.3%) patients underwent novel balloon massaging with extracorporeal
balloon inflation in saline water (group N) before the cryoballoon was inserted into
the body. The remaining 115 (65.7%) patients underwent conventional balloon massaging
in saline water while the balloon remained folded (group C). Of those, 86 propensity
score–matched patients were included.
Results
The baseline characteristics were similar between the 2 groups. In group N, even after
balloon massaging in saline water was carefully performed, multiple air bubbles remained
on the balloon surface when the cryoballoon was inflated in all cases. Postprocedural
cerebral magnetic resonance imaging detected ACE in 14.0% of all patients. The incidence
of ACE was significantly lower in group N than in group C (4.7% vs 23.3%; P = .01). According to multivariable analysis, the novel method was the sole factor
associated with the presence of ACE (odds ratio 0.161; 95% confidence interval 0.033–0.736;
P = .02).
Conclusion
Preliminary removal of air bubbles in heparinized saline water with extracorporeal
balloon inflation reduced the incidence of ACE. Since conventional balloon massaging
failed to remove air bubbles completely, this novel balloon massaging method should
be recommended before cryoballoon utilization.
Keywords
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Article info
Publication history
Published online: May 27, 2017
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