Conflict of interest statement
Authors declare no conflict of interests for this article.
To editor:
Tan and colleagues summarized real‐world clinical data on the adverse events associated with the use of cryoballoon catheters for atrial fibrillation. 1 They found that phrenic nerve palsy and cardiac perforation were the two most common procedure‐related adverse events. Although the cryoballoon catheter is not a first‐line therapy, 2 their reports using a large‐scale database are of great importance to many clinicians. Several concerns have been raised to further improve their findings.
The rate of procedure‐related complications is supposed to decline with the innovation of novel devices and improvements in procedural techniques. In another large‐scale study, the procedure‐related complication rate decreased significantly from the early era (2013 and 2017) to the late era (2018 and 2022). 3 The observation period of the authors' study was between 2011 and 2021, 1 during which the safety and feasibility of the procedures improved considerably due to the innovation of the second‐generation cryoballoon system. It may be of great interest to analyze the clinical outcomes of the second‐generation devices alone or to compare the devices (i.e., first‐generation versus second‐generation devices).
Phrenic nerve palsy and cardiac tamponade are well‐known procedure‐related complications. Most paralysis is transient. Thus, the novelty of the authors' study is unclear. For example, an intra‐age comparison of the procedure‐related complication rates may be interesting to demonstrate the feasibility of this treatment in elderly patients. A previous study demonstrated a comparable procedure‐related complication rate in elderly patients to the young patients. Observation of natural breathing during the procedure may be a key to early detection of phrenic nerve palsy. 4 How many patients received cryoballoon treatment under local anesthesia?
REFERENCES
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