Predicting Phrenic Nerve Palsy in Patients Undergoing Atrial Fibrillation Ablation With the Cryoballoon—Does Sex Matter?

Abstract

Background: Phrenicus nerve palsy (PNP) is a typical complication during pulmonary vein isolation (PVI) using the cryoballoon with the ominous potential to counteract the clinical benefit of restored sinus rhythm. According to current evidence incidence of PNP is about 5–10% of patients undergoing Cryo-PVI and is more frequent during ablation of the RSPV compared to the RIPV. However, information on patient specific characteristics predicting PNP and long-term outcome of patients suffering from this adverse event is sparse.Aim of the Study: To evaluate procedural and clinical characteristics of AF patients with PNP during cryoballoon PVI compared to patients without PNP.Methods and Results: Between 2013 and 2019 we included 632 consecutive AF patients undergoing PVI with the cryoballoon in our study. 84/632 (13.3%) patients experienced a total number of 89 PNP during the ablation procedure. 75/89 (84%) cryothermal induced PNP recovered until the end of the procedure (transient PNP, tPNP), whereas 14/89 (16%) PNP hold beyond the end of the procedure (non-transient PNP, ntPNP). Using multivariate logistic regression, we found that sex and BMI are strong and independent predictors of cryothermal induced non-transient PNP during cryoballoon PVI with an odds ratio of 3.9 (CI: 95%, 1.1–14.8, p = 0.04) for female gender. Interestingly, all patients (14/14, 100%) with a non-transient PNP experienced complete PNP resolution after a mean recovery time of 68 ± 79 days.Conclusion: Our data indicate for the first time, that female sex and lower BMI are independent predictors for non-transient PNP caused by cryoballoon PVI. Fortunately, during follow up all PNP patients resolved completely with a median recovery time of 35 days.

Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation: an observational cohort study

“…Other explanations could be that the angle between of the PV and the left atrial wall in some patients might increase the risk for phrenic nerve palsy. Furthermore, a relation between the incidence of phrenic nerve injury, female sex and lower BMI has been reported before 23 24…”

Sex differences in paroxysmal atrial fibrillation catheter ablation: A difference‐in‐difference propensity score matched analysis

“…reported that the risk of phrenic nerve injury was higher in females than in males. Multivariable regression showed that female sex and lower BMI are independent predictors of phrenic nerve injury 16 . Patient BMI is also related to periprocedural pericardial effusion.…”

“…The reasons we controlled these characteristics were: (1) women are usually older than men when they undergo catheter ablation, which may bring differences in concomitant diseases or AF recurrence risk; (2) women often receive catheter ablation later than men, which may bring differences in ablation sites or AF recurrence risk; (3) BMI is associated with more procedure-related complications. [7][8][9][10][11][12][13][14][15][16] Mean ± SD or number (percent) is used to describe the clinical char-…”

“…Besides, female patients receiving catheter ablation might have a higher AF recurrence risk than male patients 7–12 . Female patients might also have a higher risk of catheter ablation‐related complications than male patients 11,14–16 . Importantly, these differences may stem from the sexes themselves or from differences in baseline characteristics between males and females.…”

“…[7][8][9][10][11][12] Female patients might also have a higher risk of catheter ablation-related complications than male patients. 11, [14][15][16] Importantly, these differences may stem from the sexes themselves or from differences in baseline characteristics between males and females. In addition to being older, female patients are also likely to have more concomitant diseases.…”