Displaying publications 1 - 20 of 29 in total

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  1. Pok EH, Lee WJ
    World J Gastroenterol, 2014 Oct 21;20(39):14315-28.
    PMID: 25339819 DOI: 10.3748/wjg.v20.i39.14315
    Medical therapy for type 2 diabetes mellitus is ineffective in the long term due to the progressive nature of the disease, which requires increasing medication doses and polypharmacy. Conversely, bariatric surgery has emerged as a cost-effective strategy for obese diabetic individuals; it has low complication rates and results in durable weight loss, glycemic control and improvements in the quality of life, obesity-related co-morbidity and overall survival. The finding that glucose homeostasis can be achieved with a weight loss-independent mechanism immediately after bariatric surgery, especially gastric bypass, has led to the paradigm of metabolic surgery. However, the primary focus of metabolic surgery is the alteration of the physio-anatomy of the gastrointestinal tract to achieve glycemic control, metabolic control and cardio-metabolic risk reduction. To date, metabolic surgery is still not well defined, as it is used most frequently for less obese patients with poorly controlled diabetes. The mechanism of glycemic control is still incompletely understood. Published research findings on metabolic surgery are promising, but many aspects still need to be defined. This paper examines the proposed mechanism of diabetes remission, the efficacy of different types of metabolic procedures, the durability of glucose control, and the risks and complications associated with this procedure. We propose a tailored approach for the selection of the ideal metabolic procedure for different groups of patients, considering the indications and prognostic factors for diabetes remission.
  2. Lee WJ, Mohd Tahir NA, Chun GY, Li SC
    Health Qual Life Outcomes, 2024 Feb 02;22(1):14.
    PMID: 38302961 DOI: 10.1186/s12955-023-02221-y
    Understanding consequences of poor chelation compliance is crucial given the enormous burden of post-transfusional iron overload complications. We systematically reviewed iron-chelation therapy (ICT) compliance, and the relationship between compliance with health outcome and health-related quality of life (HRQoL) in thalassaemia patients. Several reviewers performed systematic search strategy of literature through PubMed, Scopus, and EBSCOhost. The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed. Of 4917 studies, 20 publications were included. The ICT compliance rate ranges from 20.93 to 75.3%. It also varied per agent, ranging from 48.84 to 85.1% for desferioxamine, 87.2-92.2% for deferiprone and 90-100% for deferasirox. Majority of studies (N = 10/11, 90.91%) demonstrated significantly negative correlation between compliance and serum ferritin, while numerous studies revealed poor ICT compliance linked with increased risk of liver disease (N = 4/7, 57.14%) and cardiac disease (N = 6/8, 75%), endocrinologic morbidity (N = 4/5, 90%), and lower HRQoL (N = 4/6, 66.67%). Inadequate compliance to ICT therapy is common. Higher compliance is correlated with lower serum ferritin, lower risk of complications, and higher HRQoL. These findings should be interpreted with caution given the few numbers of evidence.
  3. Chang SS, Chen YY, Yip PS, Lee WJ, Hagihara A, Gunnell D
    PLoS Med, 2014 Apr;11(4):e1001622.
    PMID: 24691071 DOI: 10.1371/journal.pmed.1001622
    BACKGROUND: Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995-2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

    METHODS AND FINDINGS: We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996-2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997-1999), followed by Singapore in 1999 (95% CI 1998-2001), Taiwan in 2000 (95% CI 1999-2001), Japan in 2002 (95% CI 1999-2003), and the Republic of Korea in 2007 (95% CI 2006-2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15-24 y in Japan and people aged 25-64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

    CONCLUSIONS: Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors' Summary.

  4. Takhampunya R, Kim HC, Tippayachai B, Kengluecha A, Klein TA, Lee WJ, et al.
    Virol J, 2011;8:449.
    PMID: 21943222 DOI: 10.1186/1743-422X-8-449
    Japanese encephalitis virus (JEV) genotype V reemerged in Asia (China) in 2009 after a 57-year hiatus from the continent, thereby emphasizing a need to increase regional surveillance efforts. Genotypic characterization was performed on 19 JEV-positive mosquito pools (18 pools of Culex tritaeniorhynchus and 1 pool of Cx. bitaeniorhynchus) from a total of 64 positive pools collected from geographically different locations throughout the Republic of Korea (ROK) during 2008 and 2010.
  5. Pok EH, Lee WJ, Ser KH, Chen JC, Chen SC, Tsou JJ, et al.
    Asian J Surg, 2016 Jan;39(1):21-8.
    PMID: 25964106 DOI: 10.1016/j.asjsur.2015.03.006
    Laparoscopic sleeve gastrectomy (LSG) is a popular stand-alone bariatric surgery, despite a paucity of long-term data. Hence, this study is to report the long-term outcome of LSG as primary bariatric procedure and the result of revisional surgery.
  6. Lee WJ, Tan CP, Sulaiman R, Hee YY, Chong GH
    Food Chem, 2020 Jan 30;304:125427.
    PMID: 31494501 DOI: 10.1016/j.foodchem.2019.125427
    Solution-enhanced dispersion by supercritical carbon dioxide (SEDS) and spray drying (SD) were used to microencapsulate red palm oil (RPO) to prolong the functionality of carotenes and vitamin E. The protective effects provided by SEDS and SD were evaluated in terms of the oxidative stability (65 °C for 35 days), fatty acid compositions, color change and degradation kinetics of carotenes and vitamin E (25 °C, 45 °C, 65 °C, and 85 °C for up to 198 days). SEDS microcapsules (SEDS-M) were the most oxidatively stable (total oxidation (Totox): 26.5), followed by SD microcapsules (SD-M) (34.9) and RPO (56.7). Degradation of carotenes and vitamin E fitted well a first-order kinetic model (average absolute relative deviation = 2-16%). SEDS-M offered better protection to vitamin E (Ea = 36 kJ/mol), whereas SD-M provided better protection for α + β carotene (Ea = 29 kJ/mol). Overall, encapsulation protected RPO during storage, with SEDS-microencapsulated RPO performing better than SD-microencapsulated RPO.
  7. Wang S, Lee WJ, Wang Y, Tan CP, Lai OM, Wang Y
    J Agric Food Chem, 2020 Aug 05;68(31):8391-8403.
    PMID: 32511921 DOI: 10.1021/acs.jafc.0c01346
    Medium-chain diacylglycerol (MCD), medium-long-chain diacylglycerol (MLCD), and long-chain diacylglycerol (LCD) were prepared through enzymatic esterification using different conditions at temperatures of 55-70 °C and reaction times of 1.5-5 h and in the presence of 5-6% Novozym 435. Subsequently, purification was performed using three different techniques, namely, molecular distillation (MD), deodorization (DO), and silica gel column chromatography (SGCC). Variations in terms of the physicochemical and thermodynamic properties, crystallization properties, and kinetics of the diacylglycerols (DAGs) before and after purification were determined. Irrespective of the DAG chain lengths, SGCC was able to produce samples with high DAG purity (96-99 wt %), followed by MD (58-79 wt %) and DO (39-59 wt %). A higher 1,3-DAG/1,2-DAG ratio was recorded for all samples, with the highest ratio recorded for SGCC purified samples. Regardless of the purification techniques used, the solid fat content (SFC) profiles of crude samples with steep curves were altered post-purification, showing a gradual increment in SFC along with increasing temperature. Modification of the Avrami constant and coefficient suggested the modification of the crystal growth mechanism post-purification. Crystallization and melting temperatures of products with a higher DAG purity were shifted to a higher temperature region. Variations were also reflected in terms of the crystal polymorphism, whereby the α and β' crystals transitioned into the more stable β form in purified samples accompanied by modification in the microstructures and crystal sizes. However, there was insignificant change in the morphology of MLCD crystal after purification, except for the decrease in crystal sizes. In conclusion, synthesis of MCD, MLCD, and LCD comprising different DAG purities had distinctive SFC profiles, thermodynamic properties, crystallization kinetics, and crystal morphologies, which can be further incorporated into the preparation of a variety of fat products to obtain end products with desired characteristics.
  8. Lee WJ, Goh PS, Lau WJ, Ismail AF, Hilal N
    Membranes (Basel), 2021 Mar 25;11(4).
    PMID: 33806115 DOI: 10.3390/membranes11040235
    Water constitutes one of the basic necessities of life. Around 71% of the Earth is covered by water, however, not all of it is readily available as fresh water for daily consumption. Fresh water scarcity is a chronic issue which poses a threat to all living things on Earth. Seawater, as a natural resource abundantly available all around the world, is a potential water source to fulfil the increasing water demand. Climate-independent seawater desalination has been touted as a crucial alternative to provide fresh water. While the membrane-based desalination process continues to dominate the global desalination market, the currently employed membrane fabrication materials and processes inevitably bring adverse impacts to the environment. This review aims to elucidate and provide a comprehensive outlook of the recent efforts based on greener approaches used for desalination membrane fabrication, which paves the way towards achieving sustainable and eco-friendly processes. Membrane fabrication using green chemistry effectively minimizes the generation of hazardous compounds during membrane preparation. The future trends and recommendations which could potentially be beneficial for researchers in this field are also highlighted.
  9. Chen WH, Chang CM, Mutuku JK, Lam SS, Lee WJ
    Environ Res, 2021 06;197:110975.
    PMID: 33689824 DOI: 10.1016/j.envres.2021.110975
    The deposition phenomenon of microparticle and SAR-CoV-2 laced bioaerosol in human airways is studied by Taguchi methods and response surface methodology (RSM). The data used herein is obtained from simulations of airflow dynamics and deposition fractions of drug particle aerosols in the downstream airways of asthma patients using computational fluid dynamics (CFD) and discrete particle motion (DPM). Three main parameters, including airflow rate, drug dose, and particle size, affecting aerosol deposition in the lungs of asthma patients are examined. The highest deposition fraction (DF) is obtained at the flow rate of 45 L min-1, the drug dose of 200 μg·puff-1, and the particle diameter of 5 μm. The optimized combination of levels for the three parameters for maximum drug deposition is performed via the Taguchi method. The importance of the influencing factors rank as particle size > drug dose > flow rate. RSM reveals that the combination of 30 L min-1, 5 μm, 200 μg·puff- has the highest deposition fraction. In part, this research also studied the deposition of bioaerosols contaminated with the SAR-CoV-2 virus, and their lowest DF is 1.15%. The low DF of bioaerosols reduces the probability of the SAR-CoV-2 virus transmission.
  10. Chen WH, Chang CM, Mutuku JK, Lam SS, Lee WJ
    J Hazard Mater, 2021 08 15;416:125856.
    PMID: 34492805 DOI: 10.1016/j.jhazmat.2021.125856
    Inhalation of aerosols such as pharmaceutical aerosols or virus aerosol uptake is of great concern to the human population. To elucidate the underlying aerosol dynamics, the deposition fractions (DFs) of aerosols in healthy and asthmatic human airways of generations 13-15 are predicted. The Navier-stokes equations governing the gaseous phase and the discrete phase model for particles' motion are solved using numerical methods. The main forces responsible for deposition are inertial impaction forces and complex secondary flow velocities. The curvatures and sinusoidal folds in the asthmatic geometry lead to the formation of complex secondary flows and hence higher DFs. The intensities of complex secondary flows are strongest at the generations affected by asthma. The DF in the healthy airways is 0%, and it ranges from 1.69% to 52.93% in the asthmatic ones. From this study, the effects of the pharmaceutical aerosol particle diameters in the treatment of asthma patients can be established, which is conducive to inhibiting the inflammation of asthma airways. Furthermore, with the recent development of COVID-19 which causes pneumonia, the predicted physics and effective simulation methods of bioaerosols delivery to asthma patients are vital to prevent the exacerbation of the chronic ailment and the epidemic.
  11. Mohamed AM, Wong KH, Lee WJ, Marizan Nor M, Mohd Hussaini H, Rosli TI
    Saudi Dent J, 2018 Apr;30(2):142-150.
    PMID: 29628737 DOI: 10.1016/j.sdentj.2017.12.001
    Aim: The aim of the study was to evaluate the effect of resin infiltration on colour changes and surface roughness of artificial white spot lesions (WSLs) on maxillary and mandibular premolar.

    Materials and methods: Sixty (60) extracted sound Maxilla (Mx) and Mandibular (Mn) premolars were randomly divided into 2 groups (test and control). Artificial WSLs were produced on buccal surface of teeth and were immersed in artificial saliva for 8 weeks. Colour components (L∗, a∗, b∗) and surface roughness (Sa∗) were assessed on 40 teeth using colour difference meter RD-100 and Alicona® Infinite Focus profilometer respectively. The measurements were done at baseline (T1), directly after artificial WSLs (T2), after 24 hours immersed in saliva and application of resin (T3) and immersion in artificial saliva for 1 (T4), 2 (T5), 4 (T6), 6 (T7) and 8 (T8) weeks. SEM images analysis were carried out on 20 teeth in four time points.

    Results: The values of L∗ (lightness), b∗ (yellow/blue) and Sa∗ (surface roughness) are gradually reduced to the baseline value. Whereas, the value of a∗ gradually increased with distinct treatment time to achieve the baseline value. The higher value of L∗ and Sa∗, the whiter the lesion suggesting higher degree of enamel demineralization and surface roughness. Lower L∗ values suggest a masking colour effect.

    Conclusion: The material produced favorable esthetics on colour and the surface roughness of teeth at distinct treatment times. It is recommended to be used to improve WSL post orthodontic treatment.

  12. Subramaniam S, Jeoung JW, Lee WJ, Kim YK, Park KH
    Jpn. J. Ophthalmol., 2018 Nov;62(6):634-642.
    PMID: 30229404 DOI: 10.1007/s10384-018-0620-7
    PURPOSE: To compare the diagnostic capability of three-dimensional (3D) neuro-retinal rim thickness (NRR) with existing optic nerve head and retinal nerve fiber layer (RNFL) scan parameters using high-definition optical coherence tomography (HD-OCT).

    DESIGN: Retrospective study.

    METHODS: Based on the mean deviation (MD) of the Humphrey Field Analyzer (HFA), the 152 subjects were categorized into mild (MD > - 6 dB, 100), moderate (MD - 6 to - 12 dB, 26), and severe (MD

  13. Lei M, Zhang N, Lee WJ, Tan CP, Lai OM, Wang Y, et al.
    Food Chem, 2020 May 15;312:126047.
    PMID: 31884300 DOI: 10.1016/j.foodchem.2019.126047
    Formation of foams is critical for tailoring the texture and mouthfeel of fat-based products. Diacylglycerol (DAG) is regarded as a preferable alternative structurant to hydrogenated lipid. Effect of DAG concentration (2-10 wt%) on the characteristics of oleogels and foams including crystal polymorphisms, size and distribution, rheological and thermodynamic properties was investigated. Oleogel prepared with 10 wt% DAG had comparable whipping and foaming stability to that of 6 wt% fully hydrogenated palm oil (FHPO). DAG formed small plate-crystals which tend to occur at the bubble surface, whereas FHPO showed needle-like crystals that were formed mainly in the continuous phase. For the 2 wt% FHPO-8 wt% DAG-based oil foams, interfacial templating crystallization effect contributed to the smaller bubble size and improved rheological properties whereby less oil drainage and foam breakdown occurred. Hence, the non-aqueous foam formed by DAG has broad application prospect because of the thermoresponsive properties and the desirable health benefits.
  14. Yang J, Qiu C, Li G, Lee WJ, Tan CP, Lai OM, et al.
    Food Chem, 2020 Oct 15;327:127014.
    PMID: 32434126 DOI: 10.1016/j.foodchem.2020.127014
    The influence of diacylglycerol (DAG) combined with polyglycerol polyricinoleate (PGPR) on the stability of water-in-oil (W/O) emulsions containing hydrogenated palm oil (HPO) was studied. Polarized light microscope revealed that DAG promoted HPO to crystallize at the water-oil interface, providing the combination of Pickering and network stabilization effects. It was proposed that the molecular compatibility of fatty acids in DAG with HPO accounted for the promotional effect. The interfacial crystallization of DAG together with the surface activity of PGPR led to the formation of emulsions with uniform small droplets and high freeze-thaw stability. Further exploration of physical properties indicated that the combination of DAG and PGPR dramatically improved the emulsion's viscoelasticity and obtained a larger deformation yield. Water droplets in DAG-based emulsions acted as active fillers to improve the network rigidity. Therefore, DAG is a promising material to be used as emulsifier to enhance the physical stability of W/O emulsions.
  15. Li G, Lee WJ, Tan CP, Lai OM, Wang Y, Qiu C
    Food Funct, 2021 Nov 29;12(23):11732-11746.
    PMID: 34698749 DOI: 10.1039/d1fo01883c
    Pickering water-in-oil (W/O) emulsions were fabricated by using medium-long chain diacylglycerol (MLCD)-based solid lipid nanoparticles (SLNs) and the connection between the characteristics of the SLNs and the colloidal stability of the emulsions was established. Via melt-emulsification and ultrasonication, MLCD-based SLNs with particle sizes of 120-300 nm were obtained with or without other surfactants. The particle size of the SLNs was influenced by the chemical properties of the surfactants, and surfactants decreased the contact angle of SLNs at the oil-water interface. Gelation was observed in SLNs modified by sodium stearoyl lactylate and lecithin, whereas the addition of Tween 20 resulted in a homogeneous SLN solution. The adsorption of surfactants onto SLN surfaces caused the production of higher amounts of α crystals accompanied by delayed crystallization onset which contributed to the reduction of particle size, interfacial tension and oil wetting ability. The W/O emulsions with higher rigidity and physical stability can be obtained by varying surfactant types and by increasing SLN mass ratios to 60%, whereby more SLNs are adsorbed at the droplet surface as a Pickering stabilizer. This study provides useful insights for the development of diacylglycerol-based SLNs and Pickering W/O emulsions which have great potential for food, cosmetic and pharmaceutical applications.
  16. Liu Y, Lee WJ, Tan CP, Lai OM, Wang Y, Qiu C
    Food Chem, 2022 Mar 15;372:131305.
    PMID: 34653777 DOI: 10.1016/j.foodchem.2021.131305
    High internal phase emulsions (HIPEs) show promising application in food and cosmetic industries. In this work, diacylglycerol (DAG) was applied to fabricate water-in-oil (W/O) HIPEs. DAG-based emulsion can hold 60% water and the emulsion rigidity increased with water content, indicating the water droplets acted as "active fillers". Stable HIPE with 80% water fraction was formed through the combination of 6 wt% DAG with 1 wt% polyglycerol polyricinoleate (PGPR). The addition of 1 w% kappa (κ)-carrageenan and 0.5 M NaCl greatly reduced the droplet size and enhanced emulsion rigidity, and the interfacial tension of the internal phase was reduced. Benefiting from the Pickering crystals-stabilized interface by DAG as revealed by the microscopy and enhanced elastic modulus of emulsions with the gelation agents, the HIPEs demonstrated good retaining ability for anthocyanin and β-carotene. This study provides insights for the development of W/O HIPEs to fabricate low-calories margarines, spread or cosmetic creams.
  17. Ong P, Yeh CW, Tsai IL, Lee WJ, Wang YJ, Chuang YK
    PMID: 37531681 DOI: 10.1016/j.saa.2023.123214
    Consumption of agricultural products with pesticide residue is risky and can negatively affect health. This study proposed a nondestructive method of detecting pesticide residues in chili pepper based on the combination of visible and near-infrared (VIS/NIR) spectroscopy (400-2498 nm) and deep learning modeling. The obtained spectra of chili peppers with two types of pesticide residues (acetamiprid and imidacloprid) were analyzed using a one-dimensional convolutional neural network (1D-CNN). Compared with the commonly used partial least squares regression model, the 1D-CNN approach yielded higher prediction accuracy, with a root mean square error of calibration of 0.23 and 0.28 mg/kg and a root mean square error of prediction of 0.55 and 0.49 mg/kg for the acetamiprid and imidacloprid data sets, respectively. Overall, the results indicate that the combination of the 1D-CNN model and VIS/NIR spectroscopy is a promising nondestructive method of identifying pesticide residues in chili pepper.
  18. Liu C, Wang ST, Tan CH, Lin ZE, Lee WJ
    PMID: 38422382 DOI: 10.1080/19440049.2024.2319271
    Glycidyl esters (GEs) and 3-monochloropropanediol esters (3-MCPDEs) are process contaminants commonly found in refined edible oils which are often added to infant formulas. The Taiwan Food and Drug Administration (TFDA) launched regulations for GEs in infant formulas that went into effect on 1 July 2021. To investigate levels of GEs and 3-MCPDEs in infant formula powder, 45 products were sampled and analysed during 2020-2021. The contents of GEs and 3-MCPDEs in formulas of different brands significantly varied, but their concentrations in all of the formulas complied with European Union (EU) regulations. Infant formulas containing palm oil had significantly higher 3-MCPDE levels in both extracted oils and milk powder than those without palm oil. Concentrations of GEs and 3-MCPDEs in infant formula powder and extracted oils were significantly lower in products from Europe than those from Australia and New Zealand. Infants aged 0-1 years in Taiwan who consumed only infant formula showed a margin of exposure (MoE) exceeding 25,000. Mean consumer exposures to 3-MCPDEs stayed below the tolerable daily intake (TDI), while high exposures at the 95th percentile (P95) exceeded the TDI by 1.7-fold. Herein, we present the changing trends in the risk assessment results of infant formula across various countries in the decade. Implementation of regulations and mitigation strategy effectively reduced the risk of infants being exposed to GEs and 3-MCPDEs through infant formula.
  19. Tan MC, Tan JL, Lee WJ, Srivathsan K, Sorajja D, El Masry H, et al.
    J Arrhythm, 2023 Oct;39(5):784-789.
    PMID: 37799789 DOI: 10.1002/joa3.12898
    BACKGROUND: Real-world clinical data on the adverse events related to the use of cryoballoon catheter for pulmonary vein isolation remains limited.

    OBJECTIVE: To report and describe the adverse events related to the use of Artic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, and Arctic Front Advance Pro) reported in the Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database.

    METHODS: We reviewed all the adverse events reported to the FDA MAUDE database over a 10.7-year study period from January 01, 2011 to September 31, 2021. All events were independently reviewed by two physicians.

    RESULTS: During the study period, a total of 320 procedural-related adverse events reported in the MAUDE database were identified. The most common adverse event was transient or persistent phrenic nerve palsy (PNP), accounting for 48% of all events. This was followed by cardiac perforation (15%), pulmonary vein stenosis (8%), transient ischemic attack or stroke (6%), vascular injury (4%), transient or persistent ST-elevation myocardial infarction (3%), hemoptysis (2%), pericarditis (2%), and esophageal ulcer or fistula (1%). There were six reported intra-procedural death events as a result of cardiac perforation.

    CONCLUSION: The two most common procedural adverse events associated with cryoballoon ablation were PNP and cardiac perforation. All cases of procedural mortality were due to cardiac perforation.

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