Abstract 16123: 80 % of the Patients Have a Headache During Balloon Cryoablation
Purpose Although point-by-point cryoablation (cryo) is known to result in nearly no application-related pain, recent studies reported headache during balloon cryo. The purpose of this study was to systematically evaluate headache during balloon cryo for paroxysmal atrial fibrillation (PAF).
Methods Twenty patients (15 men, 60±10 years) with PAF underwent balloon cryo without sedation. Headache was evaluated before, during and after the first application in every pulmonary vein (PV) using a visual representation of a head for exact location, a Visual Analogue Scale (VAS) for pain ranging from 0 to 10 and the short form McGill pain questionnaire. The order in which each PV was ablated, was randomized.
Results All PVs were successfully isolated with a mean of 6±1 (range 4-10) applications/patient using a 23/28 mm cryoballoon in 5/15 patients. A conventional cryocatheter was used to ablate residual myocardial tissue in 4 right inferior PVs. 16/20 (80 %) patients perceived headache during cryo. The pain was located more on the forehead compared to the orbital region or dome of the head. The mean VAS score for pain was significantly higher during (5±2) and immediately after (4±2) compared to before (2±1) a cryo application. Cryo of the first randomized PV was significantly more painful (VAS score) compared to cryo of the other PVs (5±2 vs 3±2; p<0,05). Cryo of the right superior PV was significantly less painful compared to the other veins. The short form McGill pain questionnaire yielded high ratings on sensory and affective components of pain. One patient also reported chest pain during cryo. There was no relation between cryo temperature and pain. No complications occurred.
Conclusions In the majority of patients with PAF treated by balloon cryoablation, frontal headache occurs during and immediately after an application. Cryo of the first PV was significantly more painful compared to cryo of the other PVs. The underlying mechanism of headache during cryoballoon ablation remains unclear: potential mechanisms include vagal nerve stimulation, trigeminal nerve stimulation, or hypothermia induced cerebral vasospasm.
- © 2011 by American Heart Association, Inc.