216-18: Periprocedural complications of cryoballoon-based pulmonary vein isolation in a high volume center

Backround: Second-generation cryoballoon (CB2) ablation has been emerged as an effective treatment option for symptomatic atrial fibrillation (AF) with encouraging clinical outcome data. The current study evaluates the incidence and characteristics of procedural complications in a large patient cohort with CB2-based pulmonary vein isolation (PVI).

Methods and results: Consecutive patients with symptomatic AF who underwent CB2-based ablation between July 2012 and May 2014, were assessed. Standard freeze-cycle duration was 240 sec. followed by a bonus freeze after successful PVI. A total of 177 patients (57% male; mean age 63.4± 9.9 years; mean left atrial diameter 43.5 ± 5.2mm; mean CHADS-VASc score 1.90 ± 1.38) were enrolled. 107/177 (60%) patients suffered from paroxymal, 70/177 (40%) patients from persistent AF. Mean procedure time was 118.6 ± 33.3 minutes, mean flouroscopy duration and dosage were 21.0 ± 10.3 minutes and 4209 ± 4550 cGy*cm2, respectively. Major complications occurred in 8/177 (4,5%) patients, including 1 pulmonary artery embolism and 1 groin complication requiring surgical repair. Persistent phrenic nerve palsy (PNP; still present at discharge) occurred in 5/177 (2.8%) patients, transient PNP (full recovery before discharge) in 1/177 (0.6%) patients. No atrial-to-esophageal fistula and no transitory ischemic attack/stroke occurred.

Conclusion: The overall incidence of major complications in CB2-based ablation is considerably low with an incidence of 4.5 %.