Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon

• Published in: Heart Rhythm
• Main Authors: Casado-Arroyo, R., Chierchia, G.B., Conte, G., Levinstein, M., Sieira, J., Rodriguez-Manero, M., Giovanni, G., Baltogiannis, Y., Wauters, K., Asmundis, C. de, Sarkozy, A., Brugada, P.
• Format: Article in Journal/Newspaper
• Language: unknown
• Published: 2013
• Subjects: NCEBP 14: Cardiovascular diseases; Arctic
• Online Access: http://hdl.handle.net/2066/125766; https://doi.org/10.1016/j.hrthm.2013.07.005

Item does not contain fulltext BACKGROUND: Phrenic nerve palsy (PNP) is the most frequently observed complication during cryoballoon ablation (CB; Arctic Front, Medtronic, MN) occurring in roughly 7%-9% of the cases. The new second-generation cryoballoon ablation Arctic Front Advance (CB-A) (Arctic Front) has recently been launched in the market. OBJECTIVE: To evaluate the incidence of right PNP with the new CB-A in comparison with the first-generation balloon in a series of consecutive patients that underwent pulmonary vein isolation with this modality. METHODS: The study was designed as an observational study with a prospective follow-up. In total, 121 consecutive patients were included: 80 patients with the CB (group 1) and 41 with the CB-A (group 2). RESULTS: Mean procedural times, fluoroscopic times, and time to pulmonary vein isolation documented by real-time recordings were significantly lower in group 2 (P </= .05). The occurrence of PNP was significantly higher in group 2 (6.25% [5 of 80] in group 1 vs 19.5% [8 of 41] in group 2; P = .033). At 7 months, PNP persisted in 1 (2.5%) patient in the CB-A group. CONCLUSIONS: Right PNP seems to occur in a significantly larger number of patients with the second-generation CB-A. However, this complication is reversible in nearly all cases on short-term follow-up. More refined phrenic nerve monitoring during right-sided pulmonary vein ablation and less vigorous wedging maneuvers in the pulmonary vein ostia might significantly reduce the occurrence of this complication.