Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis

Heeger, Christian-H; Popescu, Sorin; Sohns, Christian; Pott, Alexander; Metzner, Andreas; Inaba, Osamu; Straube, Florian; Kuniss, Malte; Aryana, Arash; Miyazaki, Shinsuke; Cay, Serkan; Ehrlich, Joachim; El-Battrawy, Ibrahim; Martinek, Martin; Saguner, Ardan; Tscholl, Verena; YALIN, KIVANÇ; Lyan, Evgeny; Su, Wilber; Papiashvili, Giorgi; Botros, Maichel; Gasperetti, Alessio; Proietti, Riccardo; Wissner, Erik; Scherr, Daniel; Kamioka, Masashi; Makimoto, Hisaki; Urushida, Tsuyoshi; Aksu, Tolga; Chun, Julian; AYTEMİR, KUDRET; Jedrzejczyk-Patej, Ewa; Kuck, Karl-Heinz; Dahme, Tillman; Steven, Daniel; Sommer, Philipp; Tilz, Roland

doi:10.1093/europace/euac212

Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis

Heeger C., Popescu S. S., Sohns C., Pott A., Metzner A., Inaba O., ...More

EUROPACE, vol.25, no.2, pp.374-381, 2023 (SCI-Expanded, Scopus)

Publication Type: Article / Article
Volume: 25 Issue: 2
Publication Date: 2023
Doi Number: 10.1093/europace/euac212
Journal Name: EUROPACE
Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
Page Numbers: pp.374-381
Keywords: Atrial fibrillation, Cryoballoon, Catheter ablation, Phrenic nerve injury, PULMONARY VEIN ISOLATION, 2ND-GENERATION CRYOBALLOON, ABLATION, EXPERIENCE, FREEZE, PALSY
Istanbul University-Cerrahpasa Affiliated: Yes

Abstract

Aims Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. Methods and results In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 +/- 45.1 s in patients with persistent PVI and 133.5 +/- 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. Conclusion In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures.