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Int J Cardiol. 2018 Aug 15;265:113-117. doi: 10.1016/j.ijcard.2018.03.134.

Atrioventricular conduction disturbance during pulmonary vein isolation using the second-generation cryoballoon - Vagal impact of cryoballoon ablation.

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Department of Cardiovascular medicine, Fukui University, Fukui, Japan. Electronic address:
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Department of Cardiovascular medicine, Fukui University, Fukui, Japan.
Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.



Vagal reactions of the sinus node during pulmonary vein isolation (PVI) have been reported, however, data on intra-procedural atrioventricular conduction disturbances have been sparse. The present study aimed to investigate the clinical characteristics of atrioventricular conduction block (AVB) during PVI using second-generation cryoballoons.


A total of 2252 PVs among 568 consecutive atrial fibrillation patients undergoing PVI with 28-mm cryoballoons were analyzed. In 44 patients, left superior PVs (LSPVs) were initially targeted (initial-LSPV-group). In the remaining 524 patients, LSPVs were targeted following right superior PVs (RSPVs) (initial-RSPV-group).


Marked sinus arrests/bradycardia occurred in 14 patients only in the initial-LSPV-group, and the incidence was significantly higher in the initial-LSPV than initial-RSPV-group (14/44 vs. 0/524, p < 0.001). Intra-procedural AVB with 3.6 [1.9-8.2] second maximal RR intervals appeared in 12 patients during freezing (n = 1) or after balloon deflation following freezing (n = 11). The targeted PVs were the LSPV, left common PV, right inferior PV, and RSPV in 8, 1, 2, and 1 patients, respectively. The incidence was similar between the initial-LSPV and initial-RSPV-groups (1/44 vs. 11/524, p = 0.938). Four patients exhibited complete AVB with more than a 6 s maximal RR interval. Three patients experienced AVB during atrial fibrillation. AVB was observed a median of 23.0 [15.0-70.0] seconds after balloon deflation and 76.0 [60.0-125.0] seconds after freezing termination. AVB persisted for 56.0 [36.0-110.0] seconds, and all recovered spontaneously with or without requiring back-up pacing.


A marked transient AV conduction disturbance could occur after balloon deflation, especially during LSPV ablation, regardless of the order of targeted PVs.


Atrial fibrillation; Atrioventricular conduction block; Cryoballoon; Pulmonary vein isolation; Vagal reaction

[Indexed for MEDLINE]

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