In vitro assessment of induced phrenic nerve cryothermal injury

Goff, Ryan P.; Bersie, Stephanie M.; Iaizzo, Paul A.

doi:10.1016/j.hrthm.2014.06.022

Cited by 9 publications

(2 citation statements)

References 31 publications

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“…16 Data showing that an early timed CMAP decrease was associated with a PNI recovery delay could be explained by experimental study results showing that phrenic nerve cooling to subzero temperatures consistently leads to a loss of function and the functional recovery is delayed if it is cooled at faster rates and to lower temperatures. 17 Earlier recognition of CMAP amplitude reductions and immediate active deflations appear to be essential to anticipate persistent PNI.…”

Section: Predictors Of Pni Recoverymentioning

confidence: 99%

Characteristics of Phrenic Nerve Injury During Pulmonary Vein Isolation Using a 28‐mm Second‐Generation Cryoballoon and Short Freeze Strategy

Miyazaki

Kajiyama

Watanabe

et al. 2018

JAHA

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BackgroundThe reported incidence of phrenic nerve injury (PNI) varies owing to different definitions, balloon generations, balloon size, freezing regimen, and protective maneuvers. We evaluated the incidence, predictors, and outcome of PNI during cryoballoon pulmonary vein isolation in a large population.Methods and ResultsFive hundred fifty atrial fibrillation patients underwent pulmonary vein isolation using one 28‐mm second‐generation cryoballoon and single 3‐minute freeze strategy under diaphragmatic compound motor action potential (CMAP) monitoring. A total of 34 (6.2%) patients experienced PNI during the right superior and inferior pulmonary vein ablation in 30 and 4 patients, respectively. Applications were interrupted using double‐stop techniques after 136 [104–158] second applications, and a pulmonary vein isolation was already achieved in all but one case. The baseline CMAP amplitude and timing of deflation (CMAP def) were 0.75±0.30 and 0.17±0.17 mV, respectively. Persistent atrial fibrillation, larger right superior pulmonary vein ostia, and deeper balloon positions were associated with higher incidences of PNI. The CMAP def predicted a PNI recovery delay, and the best cutoff value for predicting PNI recovery by the next day was 0.20 mV (sensitivity 57.1%, specificity 100%). Among 6 patients undergoing second procedures 8.5 (6.7–15.0) months later, the right superior pulmonary vein was durable in 3 with >120 second applications. Despite active balloon deflation, no significant pulmonary vein stenosis was observed in 15 right superior pulmonary veins evaluated 6 (5–9) months later. No patients had symptoms, and the PNI recovered 1 day and 1 month postprocedure in 21 and 4 patients, respectively.Conclusions PNI resulting from cryoballoon ablation was reversible. The double‐stop technique is safe, and immediate active deflation following a CMAP decrease appears to be essential for faster PNI recovery.

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Section: Predictors Of Pni Recoverymentioning

confidence: 99%

Characteristics of Phrenic Nerve Injury During Pulmonary Vein Isolation Using a 28‐mm Second‐Generation Cryoballoon and Short Freeze Strategy

Miyazaki

Kajiyama

Watanabe

et al. 2018

JAHA

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“…( 1 , 13 ) Though both RFA and CBA are a thermal ablation, these differences could be explained by the differences in the configuration of the ablation catheter and the mechanisms of lesion formation. ( 14 , 15 ) On the contrary, the data of symptomatic GH has been limited due to the very low incidence and non-lethal complications despite impairing the patients' quality of life. The present study, for the first time, clarified that the outcomes of symptomatic GH were similar between RFA and CBA once it occurred, although the exact incidence was unknown from the present data.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation

Miyazaki,

Kobori,

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSymptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce.ObjectiveWe compared the clinical course of SGH occurring with different energy sources.MethodsThis multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation.ResultsThe data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1–4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5–5) days; the total hospitalization duration was 11 [7–19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for >1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set.ConclusionsThe clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%.

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