TY - JOUR
T1 - Persistent phrenic nerve palsy after atrial fibrillation ablation: Follow-up data from The Netherlands Heart Registration
AU - Mol, D.
AU - Renskers, L.
AU - Balt, J.C.
AU - Bhagwandien, R.E.
AU - Blaauw, Y.
AU - van Driel, V.J.H.M.
AU - Driessen, A.H.G.
AU - Elvan, A.
AU - Folkeringa, R.
AU - Hassink, R.J.
AU - van Huysduynen, B.H.
AU - Luermans, J.G.L.M.
AU - Stevenhagen, J.Y.
AU - van der Voort, P.H.
AU - Westra, S.W.
AU - de Groot, J.R.
AU - de Jong, J.S.S.G.
AU - Netherlands Heart Registration Ablation Registration Committee
N1 - Funding Information:
D. Mol reports speaker/consultancy fee from Abbott. Dr. Y. Blaauw is a proctor for Boston Scientific, Abbott, and Medtronic and received research grants from Medtronic and Atricure. Dr. J. G. L. M Luermans reports grants from Biotronik, and a consultancy agreement with Medtronic, outside the submitted work. Dr. J. R. de Groot reports research grants to his institution from Atricure, Abbott, Boston Scientific, Medtronic, personal fees from Atricure, Bayer, Daiichi Sankyo, Servier, Johnson & Johnson, Novartis, Medtronic, outside the submitted work. Dr. J. C. Balt reports consultancy fees to his institution from Abbott. Dr. de Jong reports consultancy fees from Medtronic and speaker fees from Daiichi‐Sankyo and Bayer, outside the submitted work. Disclosures:
Publisher Copyright:
© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC
PY - 2022/3
Y1 - 2022/3
N2 - Background Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. Methods In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow-up data were collected for patients who developed persistent PNP. Results Overall, the mean age was 62 +/- 10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203 (113-351) and 184 (82-359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering <= 180 days had a larger left atrium volume index than those with late or no recovery. Conclusion After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
AB - Background Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. Methods In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow-up data were collected for patients who developed persistent PNP. Results Overall, the mean age was 62 +/- 10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203 (113-351) and 184 (82-359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering <= 180 days had a larger left atrium volume index than those with late or no recovery. Conclusion After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
KW - ablation
KW - atrial fibrillation
KW - conventional RF
KW - cryoballoon
KW - phased RF
KW - phrenic nerve palsy
KW - thoracoscopic ablation
KW - PULMONARY VEIN ISOLATION
KW - CRYOBALLOON ABLATION
KW - INJURY
KW - 2ND-GENERATION
KW - SURGERY
U2 - 10.1111/jce.15368
DO - 10.1111/jce.15368
M3 - Article
C2 - 35040534
SN - 1045-3873
VL - 33
SP - 559
EP - 564
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 3
ER -