Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation

被引:8
作者
Fueting, Anna [1 ,3 ]
Reinsch, Nico [1 ,3 ]
Brokkaar, Lenny [2 ,3 ]
Hartl, Stefan [1 ,3 ]
Hoewel, Dennis [1 ,3 ]
Essling, Anika [1 ,3 ]
Bell, John [1 ,3 ]
Rausch, Eva [1 ,3 ]
Neven, Kars [1 ,3 ]
机构
[1] Alfried Krupp Hosp, Dept Electrophysiol, Essen, Germany
[2] Alfried Krupp Hosp, Dept Pulmonol, Essen, Germany
[3] Witten Herdecke Univ, Dept Med, Witten, Germany
关键词
atrial fibrillation; bronchoscopy; catheter ablation; hemoglobin; pulmonary vein; PULMONARY VEIN ISOLATION; CRYOBALLOON ABLATION; ELECTROPORATION; HEMOPTYSIS; ARTERIES;
D O I
10.1161/CIRCEP.122.011547
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Thermal left atrial ablation can cause bronchial damage. Pulsed field ablation (PFA) is a novel, nonthermal ablation modality for paroxysmal atrial fibrillation. We report on bronchial effects after pulmonary vein isolation using PFA for paroxysmal atrial fibrillation.METHODS: A computed tomography scan showing the respiratory tract adjacent to the left atrial was obtained. Oral anticoagulation was interrupted on procedure day. Peri-procedurally, patients received heparin with an activated clotting time goal of >350 seconds. All pulmonary veins were individually isolated with a 13F steerable sheath and a pentaspline PFA catheter using either a straight-tip or J-tip guide wire. The J-tip guide wire patients were added to test the hypothesis that the straight-tip guidewire was associated with bleeding complications. One day afterward, bronchoscopy was performed. Serial hemoglobin levels were measured during 3 0-day follow-up.RESULTS: In 2 series of 30 patients, PFA was performed, with all pulmonary veins acutely isolated. Clinical course was uneventful, no patient had chest discomfort, coughing, or hemoptysis. All patients underwent uncomplicated bronchoscopy, without thermal lesions or ulcers. In 12 out of 30 (40%) straight-tip guide wire patients, small amounts of old blood without active bleeding were seen in multiple segments. All hemoglobin levels remained clinically stable. At 3 0-day follow-up, all patients were asymptomatic.CONCLUSIONS: Pulmonary vein isolation using PFA for paroxysmal atrial fibrillation does not cause thermal lesions in the bronchial system. Use of a straight-tip, extrastiff guide wire for the over-the-wire PFA catheter can lead to asymptomatic bleeding in the bronchial system without clinical relevance at 3 0-day follow-up, opposite to use of a J-tip guide wire.
引用
收藏
页数:6
相关论文
共 31 条
[1]  
de Leon Ana, 2021, J Atr Fibrillation, V14, P20200480, DOI 10.4022/jafib.20200480
[2]   Esophago-pericardial Fistula Complicating Atrial Fibrillation Ablation Using a Novel Irrigated Radiofrequency Multipolar Ablation Catheter [J].
Deneke, Thomas ;
Schade, Anja ;
Diegeler, Anno ;
Nentwich, Karin .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2014, 25 (04) :442-443
[3]   Minimal coronary artery damage by myocardial electroporation ablation [J].
du Pre, Bastiaan C. ;
van Driel, Vincent J. ;
van Wessel, Harry ;
Loh, Peter ;
Doevendans, Pieter A. ;
Goldschmeding, Roel ;
Wittkampf, Fred H. ;
Vink, Aryan .
EUROPACE, 2013, 15 (01) :144-149
[4]   First experience with pulsed field ablation as routine treatment for paroxysmal atrial fibrillation [J].
Fueting, Anna ;
Reinsch, Nico ;
Hoewel, Dennis ;
Brokkaar, Lenny ;
Rahe, Gilbert ;
Neven, Kars .
EUROPACE, 2022, :1084-1092
[5]   Acute pulmonary hemorrhage during atrial fibrillation HotBalloon ablation [J].
Fujii, Eitaro ;
Fujita, Satoshi ;
Kagawa, Yoshihiko ;
Ito, Masaaki .
JOURNAL OF ARRHYTHMIA, 2018, 34 (04) :462-464
[6]   Pulmonary vein perforation into bronchi: a rare but life-threatening complication of cryoballoon ablation [J].
Fukunaga, Hiroshi ;
Higuchi, Ryosuke ;
Tanizaki, Kohei ;
Isobe, Mitsuaki .
EUROPEAN HEART JOURNAL-CASE REPORTS, 2019, 3 (01)
[7]   2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) [J].
Hindricks, Gerhard ;
Potpara, Tatjana ;
Dagres, Nikolaos ;
Arbelo, Elena ;
Bax, Jeroen J. ;
Blomstroem-Lundqvist, Carina ;
Boriani, Giuseppe ;
Castella, Manuel ;
Dan, Gheorghe-Andrei ;
Dilaveris, Polychronis E. ;
Fauchier, Laurent ;
Filippatos, Gerasimos ;
Kalman, Jonathan M. ;
La Meir, Mark ;
Lane, Deirdre A. ;
Lebeau, Jean-Pierre ;
Lettino, Maddalena ;
Lip, Gregory Y. H. ;
Pinto, Fausto J. ;
Thomas, G. Neil ;
Valgimigli, Marco ;
Van Gelder, Isabelle C. ;
Van Putte, Bart P. ;
Watkins, Caroline L. .
EUROPEAN HEART JOURNAL, 2021, 42 (05) :373-498
[8]   Life-Threatening Massive Hemoptysis After Cryoablation for Atrial Fibrillation [J].
Jayaschandran, Vivek ;
Mertens, Amy N. ;
Patel, Vishal K. ;
Dalal, Bhavinkumar .
JOURNAL OF BRONCHOLOGY & INTERVENTIONAL PULMONOLOGY, 2018, 25 (01) :67-69
[9]   Electroporation-induced changes in normal immature rat myoblasts (H9C2) [J].
Kaminska, Iwona ;
Kotulska, Malgorzata ;
Stecka, Anna ;
Saczko, Jolanta ;
Drag-Zalesinska, Malgorzata ;
Wysocka, Teresa ;
Choromanska, Anna ;
Skolucka, Nina ;
Nowicki, Rafal ;
Marczak, Jakub ;
Kulbacka, Julita .
GENERAL PHYSIOLOGY AND BIOPHYSICS, 2012, 31 (01) :19-25
[10]   Spatial relationship between left atrial roof or superior pulmonary veins and bronchi or pulmonary arteries by dual-source computed tomography: implication for preventing injury of bronchi and pulmonary arteries during atrial fibrillation ablation [J].
Li, Yi-Gang ;
Yang, Mei ;
Li, Yuhua ;
Wang, Qunshan ;
Yu, Linwei ;
Sun, Jian .
EUROPACE, 2011, 13 (06) :809-814