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

Abstract

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.

Keywords: AAD; AF; Ablation; Atrial fibrillation; CB; CB-A; Complication; Cryoballoon; EGD; PN; PNP; PV; PVI; Phrenic nerve paralysis; Pulmonary vein isolation; RIPV; RSPV; SVC; antiarrhythmic drug treatment; atrial fibrillation; cryoballoon ablation; cryoballoon ablation Arctic Front Advance; esohagogastroduodenoscopy; phrenic nerve; phrenic nerve palsy; pulmonary vein; pulmonary vein isolation; right inferior pulmonary vein; right superior pulmonary vein; superior vena cava.