title: Impact of Pulmonary Vein Cryoballoon Ablation on Bronchial Injury.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bowers
authors.affiliation: Pulmonary Medicine Associates, Sacramento, California, USA.
authors.forename: Sa Man
authors.initials: SM
authors.lastname: Hayatdavoudi
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California, USA.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, California, USA.
authors.forename: Alaa
authors.initials: A
authors.lastname: Afify
authors.affiliation: Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, SC, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: D'Avila
authors.affiliation: Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
authors.forename: Padraig Gearoid
authors.initials: PG
authors.lastname: O'Neill
mesh_terms: D000818:Animals; D001706:Biopsy; D001980:Bronchi / Q000000981:diagnostic imaging / Q000276:immunology / Q000293:injuries* / Q000473:pathology; D001991:Bronchitis / Q000209:etiology; D001999:Bronchoscopy; D002634:Chemotaxis, Leukocyte; D003080:Cold Temperature / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000209:etiology; D055370:Lung Injury / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D008214:Lymphocytes / Q000276:immunology; D008264:Macrophages / Q000276:immunology; D023421:Models, Animal; D020556:Neutrophil Infiltration; D009504:Neutrophils / Q000276:immunology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020545:Respiratory Mucosa / Q000276:immunology / Q000293:injuries / Q000473:pathology; D034421:Sus scrofa; D013997:Time Factors
keywords: atrial fibrillation; bronchial injury; catheter ablation; cough; cryoballoon; hemoptysis