Phrenic nerve injury during ablation with the second-generation cryoballoon: analysis of the temperature drop behaviour in a large cohort of patients

Giacomo Mugnai, Carlo de Asmundis, Vedran Velagic, Burak Hünük, Erwin Ströker, Kristel Wauters, Ghazala Irfan, Ingrid Overeinder, Ebru Hacioglu, Jaime Hernandez-Ojeda, Jan Poelaert, Christian Verborgh, Gaetano Paparella, Pedro Brugada, Jean-Baptiste Chierchia

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)

Abstract

AIMS: The present study sought to analyse the relationship between the temperature drop during the cryoenergy application and the occurrence of phrenic nerve injury (PNI) in a large cohort of patients having undergone second-generation cryoballoon ablation (CB-A).

METHODS AND RESULTS: The first 550 consecutive patients having undergone CB-A for atrial fibrillation were enrolled. Attained temperatures at 20, 30, 40, and 60 s during cryoablation in the right-sided pulmonary veins (PVs) were collected. Diagnosis of PNI was made if reduced motility or paralysis of the hemidiaphragm was detected. The incidence of PNI in the study population was 7.3% (40/550); among them, only four (0.7%) did not resolve until discharge and one (0.2%) still persisted at 23 months. Patients with PNI exhibited significantly lower temperatures at 20, 30, and 40 s after the beginning of the cryoapplication in the right superior PV (RSPV) (P = 0.006, P = 0.003, and P = 0.003, respectively). The temperature drop expressed as Δ temperature/Δ time was also significantly higher in patients with PNI. Low temperature during the early phases of the freezing cycle (less than -38°C at 40 s) predicted PNI with a sensitivity of 80.5%, a specificity of 77%, and a negative predictive value of 97.9%. Among patients with a fast temperature drop during RSPV ablation, an RSPV diameter >23.55 × 17.95 mm significantly predicted PNI occurrence.

CONCLUSION: The analysis of the temperature course within the first 40 s after the initiation of the freezing cycle showed that the temperature dropped significantly faster in patients with PNI during ablation in the RSPV.

Original languageEnglish
Pages (from-to)702-709
Number of pages8
JournalEuropace
Volume18
Issue number5
DOIs
Publication statusPublished - May 2016

Keywords

  • Atrial fibrillation
  • Cryoballoon
  • Phrenic nerve injury
  • Pulmonary vein isolation

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