Persistent phrenic nerve palsy after atrial fibrillation ablation: Follow-up data from The Netherlands Heart Registration

D. Mol*, L. Renskers, J.C. Balt, R.E. Bhagwandien, Y. Blaauw, V.J.H.M. van Driel, A.H.G. Driessen, A. Elvan, R. Folkeringa, R.J. Hassink, B.H. van Huysduynen, J.G.L.M. Luermans, J.Y. Stevenhagen, P.H. van der Voort, S.W. Westra, J.R. de Groot, J.S.S.G. de Jong, Netherlands Heart Registration Ablation Registration Committee

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)559-564
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume33
Issue number3
Early online date28 Jan 2022
DOIs
Publication statusPublished - Mar 2022

Keywords

  • ablation
  • atrial fibrillation
  • conventional RF
  • cryoballoon
  • phased RF
  • phrenic nerve palsy
  • thoracoscopic ablation
  • PULMONARY VEIN ISOLATION
  • CRYOBALLOON ABLATION
  • INJURY
  • 2ND-GENERATION
  • SURGERY

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