title: Major complications of cryoballoon catheter ablation for atrial fibrillation and their management.
abstract: Atrial fibrillation (AF) is the most common symptomatic and sustained cardiac arrhythmia. It affects approximately 2-3 million people in the USA alone with an increased incidence and prevalence worldwide. It is associated, in addition to worsening quality of life, with increased morbidity and mortality especially in poorly controlled AF, affecting mostly those older than 65 years of age. Radiofrequency ablation was found to be a good strategy for focal isolation of pulmonary veins triggering from the vulnerable atrial substrate but is a time-consuming procedure and carries the risk of multiple complications like tamponade which could be fatal, atrioesophageal fistula and local thrombus formation at the site of ablation. Cryoballoon ablation with pulmonary vein isolation has emerged in the past few years as a breakthrough novel technology for the treatment of drug-refractory AF. It is a relatively simple alternative for point-by-point radiofrequency ablation of paroxysmal AF and is associated with fewer incidences of fatal complications such as cardiac perforation. As experience with this new tool accumulates, the field faces new challenges in the form of rare compilations including gastroparesis, phrenic nerve palsy, atrioesophageal fistula, pulmonary vein stenosis, thromboembolism pericardial effusion, and tamponade.
authors.affiliation: Division of Cardiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA.
authors.forename: Tariq
authors.initials: T
authors.lastname: Bhat
authors.forename: Hassan
authors.initials: H
authors.lastname: Baydoun
authors.forename: Deepak
authors.initials: D
authors.lastname: Asti
authors.forename: Jharendra
authors.initials: J
authors.lastname: Rijal
authors.forename: Sumaya
authors.initials: S
authors.lastname: Teli
authors.forename: Mohmad
authors.initials: M
authors.lastname: Tantray
authors.forename: Hilal
authors.initials: H
authors.lastname: Bhat
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011667:Pulmonary Veins; D011788:Quality of Life
keywords: ablation; atrial fibrillation; complications; cryoablation