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Phrenic nerve injury during pulmonary vein isolation using the second-generation cryoballoon: first results of the worldwide YETI registry

Session Best graded abstracts

Speaker Associate Professor Christian-Hendrik Heeger

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Rhythm Control, Catheter Ablation
  • Session type : Abstract Session
  • FP Number : 846

Authors : CH Heeger (Luebeck,DE), A Pott (Ulm,DE), A Rillig (Hamburg,DE), A Metzner (Hamburg,DE), S Cay (Ankara,TR), N Grosse (Luebeck,DE), S Miyazaki (Tsuchiura, Ibaraki,JP), A Arash (Sacramento,US), JR Ehrlich (Wiesbaden,DE), H Wirth (Ulm,DE), V Tscholl (Berlin,DE), KH Kuck (Hamburg,DE), T Dahme (Ulm,DE), RR Tilz (Luebeck,DE)

CH Heeger1 , A Pott2 , A Rillig3 , A Metzner3 , S Cay4 , N Grosse1 , S Miyazaki5 , A Arash6 , JR Ehrlich7 , H Wirth2 , V Tscholl8 , KH Kuck3 , T Dahme2 , RR Tilz1 , 1University of Luebeck, Medical clinic II - Luebeck - Germany , 2Cardiology - Ulm - Germany , 3Asklepios Clinic St. Georg, Department of Cardiology - Hamburg - Germany , 4Yuksek Ihtisas Heart-Education and Research Hospital - Ankara - Turkey , 5Tsuchiura Kyodo Hospital - Tsuchiura, Ibaraki - Japan , 6Mercy Heart Institute - Sacramento - United States of America , 7St. Josefs-Hospital , Cardiology - Wiesbaden - Germany , 8Charite - Campus Benjamin Franklin, Cardiology - Berlin - Germany ,


Background: Second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI) has emerged as a safe and effective treatment option for symptomatic atrial fibrillation (AF). Although published complication rates of CB2 based-PVI are relatively low and several safety algorithms have been implemented in the protocols the most frequent complication is right-sided phrenic nerve injury (PNI). The reported incidence of PNI varies from 2-5% of patients. However data on PNI characteristics as well as follow-up is sparse.

Purpose: We aimed to evaluate the incidence, characteristics and outcome of PNI during after CB2 based-PVI in a large patients population.

 Methods: From July 2012 to August 2018 a total of 5371 patients received CB2 based-PVI in nine EP centers (Germany: 6, Turkey: 1, Japan: 1, USA: 1).
Resuls: A total of 209 (3.9%) of patients experienced PNI during treatment of the right superior (82%) or inferior (18%) pulmonary vein. The mean time to PNI was 124±48 seconds and the mean temperature at the time of PNI was -48.7±8 °C. The applications were interrupted using double-stop technique in 189/209 (90%). In 146/209 (70%) a CMAP was utilized. At the end of the procedure  PNI persistent in 42.6% of patients. Fluoroscopic or sonographic evaluation of PNI was performed 1-3 days after the procedure and revealed persistent PNI in 28.2% of patients. Dyspnea before discharge was reported in 10% of patients with persistent PNI. Patients follow up at 1-3, and 6-12 months included fluoroscopy and a visit in an outpatient clinic. After 1-3 months 12% of patients showed persistent PNI including 6.7% of patients complaining of dyspnea. After 6-12 months of follow-up including fluoroscopic evaluation PNI was persistent in 3.3% of patients while dyspnea was reported by 1.4% patients. Overall permanent PNI after 6-12 months was evaluated in 0.13% of patients. Only 0.06% of the overall population of 5371 patients showed permanent and symptomatic PNI.
Clonclusion: The incidence of PNI during CB2-based PVI is low. About 57.4% of PNI recovered until the end of the procedure. Most of PNI resulting from CB2-based PVI recovered after 12 months. Symptomatic permanent PNI is very rare in patients after CB2-based PVI.

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