First description of a double‐wall balloon breach during cryoballoon ablation for atrial fibrillation

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The cryoballoon catheter is an established system for the treatment of patients with drug refractory symptomatic paroxysmal atrial fibrillation (AF) by pulmonary vein isolation (PVI), and the overall efficacy and safety profile is equivalent to that of radiofrequency ablation catheters.1 However, the delivery systems and energies being transferred are different.2 Primarily, the cryoballoon catheter delivers cold instead of heat, and it uses a balloon rather than focal‐tipped applications for intracardiac catheter ablation. There are safety systems in the cryoballoon catheter that help avoid and/or mitigate a balloon‐wall breach, but double‐wall breaches are possible and five instances of complete wall breach have been documented worldwide since the introduction of the Arctic Front (Medtronic, Minneapolis, MN, USA) series of cryoballoon catheters. While these balloon breaches have been rare (five cases in 250,000 procedures; 0.002%), there is need for more generalized physician awareness of the potential failure(s) and what can be done during the procedure to mitigate further patient complications when a breach occurs.
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