title: Complications of circumferential pulmonary vein isolation using the cryoballoon technique: Incidence and predictors.
abstract: BACKGROUND
  Cryoballoon ablation technique for the treatment of atrial fibrillation (AF) is a complex procedure consisting of several procedural steps associated with significant risk of complications. The aim of this single-centre study was to give detailed analysis of the complication rate and corresponding risk factors of pulmonary veins cryoisolation (PVI) procedures.
  
  
  RESULTS
  A total of 158 consecutive patients (71.5% men, aged 57 ± 9 years, 73.3% paroxysmal atrial fibrillation) were enrolled. Out of 632 pulmonary veins, 96.7% were targeted and isolated by 2-7 applications of cryothermal energy guided with intracardiac echocardiography and fluoroscopy. The additional ablation of cavotricuspid isthmus was performed in 14.6% of procedures. In total, 29 complications were recorded in peri-procedural or early post-procedural period, 8 (5.1%) of them being evaluated as major. No case of permanent injury, disability or death was registered. Multivariate logistic regression showed the persistence of pre-ablation AF as the risk factor of major complications (OR=5.0; ± 95% CI: 1.14-21.97, P=0.033); lower body height was the significant risk factor of any complications (OR=0.95; ± 95% CI: 0.91-0.99, P=0.026) with rapid increase of complication risk with body height ≤ 162 cm. Embolic complications were significantly associated with the pre-ablation AF, while patients with low body height had a trend towards increased risk of phrenic nerve palsy.
  
  
  CONCLUSIONS
  Our study confirmed that the cryoballoon pulmonary vein isolation can be safely performed with low incidence of life-threatening complications which may be further decreased if the mentioned risk factors are handled appropriately.
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia; Pavol Jozef Šafárik University, Košice, Slovakia. Electronic address: alexanderboho@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bohó
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mišíková
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia.
authors.forename: Peter
authors.initials: P
authors.lastname: Spurný
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia.
authors.forename: Erika
authors.initials: E
authors.lastname: Komanová
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia.
authors.forename: Adriana
authors.initials: A
authors.lastname: Sudzinová
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia; Comenius University, Bratislava, Slovakia.
authors.forename: Marek
authors.initials: M
authors.lastname: Hudák
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia; Comenius University, Bratislava, Slovakia.
authors.forename: Michal
authors.initials: M
authors.lastname: Kerekanič
authors.affiliation: Cardiology Clinic, Arrhythmology Section, Eastern Slovakia Institute for Cardiac and Vascular Diseases, Košice, Slovakia; Pavol Jozef Šafárik University, Košice, Slovakia.
authors.forename: Branislav
authors.initials: B
authors.lastname: Stančák
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000209:etiology; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D002305:Cardiac Tamponade / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D010791:Phrenic Nerve / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
keywords: Ablation; Atrial fibrillation; Complications; Cryoballoon; Predictors