TY - JOUR
T1 - Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury
AU - Aryana, Arash
AU - Bowers, Mark R.
AU - Hayatdavoudi, Sa Man
AU - Zhang, Yanhong
AU - Afify, Alaa M
AU - D'avila, AndrÉ
AU - O'neill, Padraig Gearoid
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Introduction: There is a paucity of data on the mechanisms of cough and hemoptysis that sometimes ensue from cryoballoon ablation of pulmonary veins (Cryo-PV). This study specifically examined the impact of ultra-cold (≤−60 °C, 3 minutes), prolonged (>−55 °C, 6 minutes), and conventional (>−55 °C, 3 minutes) Cryo-PV on lung/bronchial injury. Methods and Results: Four healthy adult swine underwent Cryo-PV. Each animal received Cryo-PV to the inferior common trunk and the right superior PV. In 2 animals, 1 PV was treated with 2 ultra-cold (Cryo-AUltra-cold) and the other with 2 conventional (Cryo-AConventional) cryoapplications. In the other 2 animals, 1 PV was ablated using 2 prolonged (Cryo-BProlonged) and the other with 2 conventional (Cryo-BConventional) applications. The nadir cryoballoon temperatures were lower in Cryo-AUltra-cold versus Cryo-AConventional (−66 ± 6 °C vs. −45 ± 5 °C; P = 0.001), but did not differ between Cryo-BProlonged and Cryo-BConventional (−46 ± 3 °C vs. −49 ± 3 °C; P = 0.123). Post-ablation bronchoscopy revealed immediate mucosal edema and erythema with/without bleeding in the adjacent bronchi in 100% of Cryo-AUltra-cold and 50% of Cryo-AConventional/Cryo-BConventional and Cryo-BProlonged. At 4 hours post-ablation, there were marked increases in bronchoalveolar macrophages (P <0.001), lymphocytes (P = 0.035) and neutrophils (P = 0.001). Furthermore, Cryo-AUltra-cold yielded the largest increase in the macrophage (P = 0.005) and neutrophil (P = 0.034) cell counts. While similar trends were seen in Cryo-BProlonged, these did not reach statistical significance. Conclusion: Cryo-PV can elicit acute bronchial inflammation, bleeding, and mucosal injury. While this was further augmented by ultra-cold cryoapplications, it was also evident to a lesser degree with prolonged and even conventional cryoapplications. The mechanism for this appears to be direct collateral injury.
AB - Introduction: There is a paucity of data on the mechanisms of cough and hemoptysis that sometimes ensue from cryoballoon ablation of pulmonary veins (Cryo-PV). This study specifically examined the impact of ultra-cold (≤−60 °C, 3 minutes), prolonged (>−55 °C, 6 minutes), and conventional (>−55 °C, 3 minutes) Cryo-PV on lung/bronchial injury. Methods and Results: Four healthy adult swine underwent Cryo-PV. Each animal received Cryo-PV to the inferior common trunk and the right superior PV. In 2 animals, 1 PV was treated with 2 ultra-cold (Cryo-AUltra-cold) and the other with 2 conventional (Cryo-AConventional) cryoapplications. In the other 2 animals, 1 PV was ablated using 2 prolonged (Cryo-BProlonged) and the other with 2 conventional (Cryo-BConventional) applications. The nadir cryoballoon temperatures were lower in Cryo-AUltra-cold versus Cryo-AConventional (−66 ± 6 °C vs. −45 ± 5 °C; P = 0.001), but did not differ between Cryo-BProlonged and Cryo-BConventional (−46 ± 3 °C vs. −49 ± 3 °C; P = 0.123). Post-ablation bronchoscopy revealed immediate mucosal edema and erythema with/without bleeding in the adjacent bronchi in 100% of Cryo-AUltra-cold and 50% of Cryo-AConventional/Cryo-BConventional and Cryo-BProlonged. At 4 hours post-ablation, there were marked increases in bronchoalveolar macrophages (P <0.001), lymphocytes (P = 0.035) and neutrophils (P = 0.001). Furthermore, Cryo-AUltra-cold yielded the largest increase in the macrophage (P = 0.005) and neutrophil (P = 0.034) cell counts. While similar trends were seen in Cryo-BProlonged, these did not reach statistical significance. Conclusion: Cryo-PV can elicit acute bronchial inflammation, bleeding, and mucosal injury. While this was further augmented by ultra-cold cryoapplications, it was also evident to a lesser degree with prolonged and even conventional cryoapplications. The mechanism for this appears to be direct collateral injury.
KW - atrial fibrillation
KW - bronchial injury
KW - catheter ablation
KW - cough
KW - cryoballoon
KW - hemoptysis
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U2 - 10.1111/jce.12983
DO - 10.1111/jce.12983
M3 - Article
C2 - 27062526
AN - SCOPUS:84978796118
VL - 27
SP - 861
EP - 867
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 7
ER -