Techniques for reducing air bubble intrusion into the left atrium during radiofrequency catheter and cryoballoon ablation procedures: An ex vivo study with a high-resolution camera.
Atrial fibrillation
Catheter ablation
Complication
Cryoballoon
Embolism
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
03
02
2018
pubmed:
4
8
2018
medline:
4
9
2020
entrez:
4
8
2018
Statut:
ppublish
Résumé
Air embolisms are serious complications during catheter ablation procedures. The aims of the present study were to determine when air bubbles enter the left atrium (LA) during catheter ablation procedures and to identify techniques that reduce air bubble intrusion. An ex vivo study was performed to monitor air bubbles using a silicone heart model and a high-resolution camera. In total, 280 radiofrequency catheter and cryoballoon ablation processes were tested. Small and large air bubbles were often observed during catheter ablation processes. Many small air bubbles arose during sheath flushing at fast speeds (15 mL/2 s) (median bubble number [quartiles]: 35 [20-53] for SL0, 35 [23-44] for Agilis, and 98 [91-100] for FlexCath) and during initial cryoballoon inflation/freezing/deflation (34 [22-47]). Large (≥1.5 mm) air bubbles were observed during Lasso catheter insertion (1 [0-1]), cryoballoon insertion (2 [1-2]), and initial inflation/freezing/deflation (1 [1-3]). Massive air bubbles were observed during Optima catheter insertion into the sheath using an inserter (10 [2-15]). Sheath flushing at slow speeds (15 mL/5 s) significantly reduced the number of air bubbles. Before cryoballoon insertion, temporary balloon inflation and air bubble removal from the inflated surface were most effective in reducing air bubble intrusions. Optima catheter insertion without an inserter significantly reduced large air bubble intrusion. Air bubbles entered the LA at specific times. Techniques such as sheath flushing at slow speeds, temporary cryoballoon inflation before insertion, inserting the Optima catheter without an inserter, and avoidance of negative pressure in the LA could reduce air bubble intrusion.
Sections du résumé
BACKGROUND
Air embolisms are serious complications during catheter ablation procedures.
OBJECTIVES
The aims of the present study were to determine when air bubbles enter the left atrium (LA) during catheter ablation procedures and to identify techniques that reduce air bubble intrusion.
METHODS
An ex vivo study was performed to monitor air bubbles using a silicone heart model and a high-resolution camera. In total, 280 radiofrequency catheter and cryoballoon ablation processes were tested.
RESULTS
Small and large air bubbles were often observed during catheter ablation processes. Many small air bubbles arose during sheath flushing at fast speeds (15 mL/2 s) (median bubble number [quartiles]: 35 [20-53] for SL0, 35 [23-44] for Agilis, and 98 [91-100] for FlexCath) and during initial cryoballoon inflation/freezing/deflation (34 [22-47]). Large (≥1.5 mm) air bubbles were observed during Lasso catheter insertion (1 [0-1]), cryoballoon insertion (2 [1-2]), and initial inflation/freezing/deflation (1 [1-3]). Massive air bubbles were observed during Optima catheter insertion into the sheath using an inserter (10 [2-15]). Sheath flushing at slow speeds (15 mL/5 s) significantly reduced the number of air bubbles. Before cryoballoon insertion, temporary balloon inflation and air bubble removal from the inflated surface were most effective in reducing air bubble intrusions. Optima catheter insertion without an inserter significantly reduced large air bubble intrusion.
CONCLUSION
Air bubbles entered the LA at specific times. Techniques such as sheath flushing at slow speeds, temporary cryoballoon inflation before insertion, inserting the Optima catheter without an inserter, and avoidance of negative pressure in the LA could reduce air bubble intrusion.
Identifiants
pubmed: 30075279
pii: S1547-5271(18)30787-2
doi: 10.1016/j.hrthm.2018.07.038
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
128-139Informations de copyright
Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.