Incidence of pericardial effusion following cryoballoon ablation for atrial fibrillation in a substantial cohort of patients

Background. As an increasing number of electrophysiology laboratories perform pulmonary vein isolation (PVI) for the treatment of drug resistant atrial fibrillation (AF), safety issues are of primary importance. Pericardial effusion (PE) is a well recognized adverse effect of this procedure. Recently, novel balloon catheters such as the Arctic Front cryoballoon (Cryocath, Medtronic, USA) (CB) have proven very effective in achieving PVI. However only limited data is available regarding the incidence of PE following CB ablation. Thus, in a substantial cohort of patients, we investigated the incidence and clinical manifestation s of PE following PVI with this technology. Methods and Results. A total of 96 patients (78 males; mean age 60 ± 5,4) were included in the study. All patients underwent 2D transthoracic echocardiogram the day before and the day after ablation as routinely performed in our centre. Inclusion criteria were: highly symptomatic paroxysmal AF resistant to > 2 anti-arrhythmic drugs, exclusion criteria: presence of LAA thrombus, decompensated heart failure and evidence of preprocedural pericardial effusion. One patient was excluded because of presence of PE in the preprocedural TTE. Mean procedural time was 135 ± 28 min. Mean duration of freezing time per patient was 40 ± 8 min). All PVs were isolated at the end of all procedures. Pericardial effusion was detected in 8 patients (8,5%) at the post procedural TTE. Seven (7,3%) were classified as mild( < 10 mm). One patient experienced a pericardial tamponade shortly after transseptal puncture. At serial control echoes following ablation, pericardial effusion completely resolved after a mean 4 ± 1 months. None of the patients exhibiting mild pericardial effusion experienced any related symptoms. Four additional hospitalization days were necessary for the patient who experienced pericardial tamponade. Older age was found an independent predictor of PE (p < 0,05). Conclusion. Pericardial effusion occurs in a relatively small proportion of patients following CB ablation for AF. Furthermore, PE is nearly always mild, asymptomatic without requiring additional hospitalization days. Based on this data, a systematic post procedural TTE might not be mandatory following CB ablation, particularly if dealing with asymptomatic patients.