| Summary: | Introduction: Cryoballoon has been effectiveness in treating atrial fibrillation; however it has also been associated with phrenic nerve injury during right-sided pulmonary vein ablation. The use of a proximal seal method would be able to mechanically increase the distance between the cryoballoon and the phrenic nerve and thereby reduce the incidence of phrenic nerve. However, the significance of this maneuver has not been objectively evaluated. Methods: Single center experience of cryoballoon ablation using Arctic Front Advance cryoballoon was reviewed. Incidence of phrenic nerve involvement was collected and binned into transient paralysis with recovery during the case, transient paralysis with recovery prior to discharge, or paralysis greater than 24 hours. Results were compared to historical data of phrenic nerve injury in STOP-AF trial where the proximal seal technique was not utilized. Result: 512 cases of cryoballoon ablation were reviewed from a single center where proximal seal method was used. 14 of 512 patients (2.7%) were identified to have phrenic nerve involvement-- 10 of 14 (71%) patients phrenic nerve recovered during the procedure, 3 of 14 (21%) patients phrenic nerve recovered prior to discharge, and 1 of 14 (7%) patient had prolonged phrenic nerve injury greater than 24 hours. Compared to historic data without proximal seal method, phrenic injury rate of 11.2% was reported in the STOP-AF trial. Conclusion: Phrenic nerve injury is a serious complication of cryoballoon ablation and representing a significant adverse outcome in STOP AF Trial. Utilizing the proximal seal method demonstrated significantly less phrenic nerve injury. Further studies are required to better understand the mechanisms of phrenic injury and improve the safety of cryoballoon ablation.
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