Abstract 16417: Multi-Center Experience in Reduction of Phrenic Nerve Injury With Second Generation Cryoballoon Ablation Using the Proximal Seal Method
Introduction: Cryoballoon ablation has proved effective in treating atrial fibrillation, but has been complicated on occasion by Phrenic Nerve Injury (PNI). Our hypothesis is that the Proximal-Seal Technique (PST) can reduce PNI rates by increasing the distance between the cryoballoon and phrenic nerve. The significance of this maneuver has not been objectively evaluated.
Methods: Multi-center experience of cryoballoon ablation using the Arctic Front Advance Second Generation Cryoballoon was reviewed. The phrenic nerve was monitored using continuous pacing and confirmation of diaphragmatic contraction by direct palpation. Incidence of PNI was collected for standard cryoablation (control group) and for cryoablation using the PST (test group). Data for PNI was further binned into Transient PNI with recovery during the case or Persistent PNI, which lasted post-discharge. Results were compared looking at incidence of PNI in each group as well as incidence of Persistent PNI.
Results: 1,082 cases of cryoballoon ablation from two centers were analyzed. 871 cases (80%) were performed using the PST while 211 cases (20%) were performed using standard techniques. PNI rate was higher in the control group 6% (13 of 211 patients) versus the test group with 0.34% (3 of 871 patients). For those with PNI in the control group, 10 (77%) patients had transient PNI and 3 (23%) patients had Persistent PNI. All of the patients with persistent PNI recovered without further complications within 30 days. 100% of patients with PNI in the test group were transient, with complete recovery prior to completion of the procedure.
Conclusion: PNI can be a significant complication of the second-generation cryoballoon as demonstrated by multiple studies. Many methods have been demonstrated to monitor for PNI, but there has not been a technique proven to reduce the incidence of PNI. In conclusion, utilizing the PST can significantly reduce the incidence of PNI. Further studies are still required to better understand the mechanisms of phrenic injury and improve the safety of cryoballoon ablation.
Author Disclosures: Z. Ahmad: None. J. Svinarich: None. A. Williams: None. W. Su: Research Grant; Modest; St Jude. Research Grant; Significant; medtronic. Honoraria; Modest; St Jude. Honoraria; Significant; Medtronic. Other; Modest; St Jude. Other; Significant; Medtronic.
- © 2016 by American Heart Association, Inc.