Long-term course of phrenic nerve injury after cryoballoon ablation of atrial fibrillation

Abstract

While phrenic nerve palsy (PNP) due to cryoballoon pulmonary vein isolation (PVI) of atrial fibrillation (AF) was transient in most cases, no studies have reported the results of the long-term follow-up of PNP. This study aimed to summarize details and the results of long-term follow-up of PNP after cryoballoon ablation. A total of 511 consecutive AF patients who underwent cryoballoon ablation was included. During right-side PVI, the diaphragmatic compound motor action potential (CMAP) was reduced in 46 (9.0%) patients and PNP occurred in 29 (5.7%) patients (during right-superior PVI in 20 patients and right-inferior PVI in 9 patients). PNP occurred despite the absence of CMAP reduction in 0.6%. The PV anatomy, freezing parameters and the operator’s proficiency were not predictors of PNP. While PNP during RSPVI persisted more than 4 years in 3 (0.6%) patients, all PNP occurred during RIPVI recovered until one year after the ablation. However, there was no significant difference in the recovery duration from PNP between PNP during RSPVI and RIPVI. PNP occurred during cryoballoon ablation in 5.7%. While most patients recovered from PNP within one year after the ablation, PNP during RSPVI persisted more than 4 years in 0.6% of patients.

Persistent phrenic nerve palsy after atrial fibrillation ablation: Follow‐up data from The Netherlands Heart Registration

“…PNP fully recovered in 71% of the patients and 86% were free of PNP‐related symptoms. These findings are in line with other studies reporting phrenic nerve recovery in 78%–100% of the patients 3–5,9 . After thoracoscopic ablation, PNP has been described in up to 11% of the patients, of whom 80% recovers within 12 months of follow‐up 6 .…”

“…These findings are in line with other studies reporting phrenic nerve recovery in 78%–100% of the patients. 3 , 4 , 5 , 9 After thoracoscopic ablation, PNP has been described in up to 11% of the patients, of whom 80% recovers within 12 months of follow‐up. 6 In contrast to catheter ablation, PNP during thoracoscopic ablation can also occur after a blunt trauma from manipulation of ablation and endoscopic tools or traction on the pericardial cradles.…”

“…8 Persistent PNP after AF ablation is a well-known complication, but data on its reversibility is sparse or limited to CB ablation. [3][4][5][6]9 We investigated rates of PNP-related symptoms and PNP recovery, and identified baseline variables associated with persistent PNP after AF ablation.…”

Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta‐analysis

“…Again, as mentioned previously, we do not know if there is a difference in target atrial tissue temperature between both platforms. Most patients recover from PNP during long‐term follow‐up using the fourth‐generation AFA‐Pro 20 . We expect that PNP recovery will also occur in the majority of patients using POLARx, however, currently there is limited published data on the long‐term outcome of acute PNP with this novel system 21 .…”

“…Most patients recover from PNP during long‐term follow‐up using the fourth‐generation AFA‐Pro. 20 We expect that PNP recovery will also occur in the majority of patients using POLARx, however, currently there is limited published data on the long‐term outcome of acute PNP with this novel system. 21 The study of Anic et al presented 1‐year follow‐up data of 24 patients undergoing cryoablation with POLARx.…”