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Phrenic nerve damage after atrial fibrillation ablation using second generation cryoballoon

Session Poster Session 2

Speaker Metin Oksul

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Catheter Ablation of Arrhythmias
  • Session type : Poster Session

Authors : H Yorgun (Ankara,TR), M Oksul (Ankara,TR), YZ Sener (Ankara,TR), U Canpolat (Ankara,TR), B Evranos (Ankara,TR), AH Ates (Ankara,TR), K Aytemir (Ankara,TR)

H. Yorgun1 , M. Oksul1 , Y.Z. Sener1 , U. Canpolat1 , B. Evranos1 , A.H. Ates1 , K. Aytemir1 , 1Hacettepe University, Department of Cardiology - Ankara - Turkey ,

Catheter Ablation of Arrhythmias

European Heart Journal ( 2019 ) 40 ( Supplement ), 1155

Background: Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure.

Purpose: In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients.

Methods: In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PND was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure.

Results: Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25–78) years and 10 patients (43.4%) were male. The most common ablation site related with PND was right superior pulmonary vein (RSPV) (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit.

Conclusion: PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.

Table 1. Baseline characteristics of patients with PND
Age (years), median (min–max)56 (25–78)
Gender, n (male %)10 (43.4%)
Hypertension, n (%)9 (39.1%)
LA (mm), (mean ± sd)38.5±5.8
EF (%), (mean ± sd)60.8±6.5
Structrual heart disease, n (%)3 (0.13%)
– HCMP2 (0.087%)
– DCMP1 (0.043%)
DCMP: Dilated cardiomyopathy; HCMP: Hypertrophic cardiomyopathy; EF: Ejection fraction; LA: Left atrium; PND: Phrenic nerve damage.

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