Document Detail

Phrenic nerve palsy during ablation of atrial fibrillation using a 28-mm cryoballoon catheter: predictors and prevention.
MedLine Citation:
PMID:  23090778     Owner:  NLM     Status:  Publisher    
PURPOSE: The purposes of this study were to determine whether predictors of phrenic nerve palsy (PNP) exist and to test whether a standardized ablation protocol may prevent PNP during cryoballoon (CB) ablation using the 28 mm CB. METHODS: Three-dimensional (3D) geometry of the pulmonary veins (PV) and their relationship to the superior vena cava (SVC) was analyzed. Phrenic nerve (PN) stimulation was performed during ablation of the right-sided PVs with a 28-mm CB. The freezing cycle was immediately terminated in case of loss of PN capture. RESULTS: Sixty-five patients (age, 58 ± 11 years; ejection fraction, 0.59 ± 0.06; left atrial size, 40 ± 5 mm) with paroxysmal atrial fibrillation were included. No persistent PNP was observed. Transient PNP occurred in 4 of 65 patients (6 %). PN function normalized within 24 h in all four patients. A short distance between the right superior PV and the SVC was significantly associated with PNP, but left atrial and 3D PV anatomy were not. Low temperature early during the freezing cycle (<-41 °C at 30 s) predicted PNP with a sensitivity and a specificity of 100 and 98 %, respectively. CONCLUSION: The anatomical relationship between the right superior PV and the SVC is a preprocedural predictor for the development of transient PNP, and low temperature early during ablation at the right superior PV is a sensitive warning sign of impending PNP. Despite the use of the 28 mm CB, transient PNP occurred in 6 % of patients undergoing CB ablation.
Michael Kühne; Sven Knecht; David Altmann; Nadine Kawel; Peter Ammann; Beat Schaer; Stefan Osswald; Christian Sticherling
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-23
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  -     ISSN:  1572-8595     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Division of Cardiology, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland,
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