Persistent phrenic nerve palsy after atrial fibrillation ablation: follow-up data from the Netherlands Heart Registration. (19th May 2022)

• Record Type: Journal Article
• Authors: Mol, D; Renskers, L; De Groot, JR; De Jong, JSSG
• Is Part Of: Europace. Volume 24:Supplement 1(2022)
• Publication Date: 2022-05-19
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac053.189
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background: Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24hours. Purpose: This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. Methods: In this study, we used data from the Netherlands Heart Registration, comprising data from 9, 549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7, 433 procedures, and additional follow-up data were collected for patients who developed persistent PNP. Results: Overall, mean age was 62±10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25% for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203[113 – 351] and 184[82 – 359] days, respectively (Figure 1A/C). In addition, in 20/28 (71.4%) patients recovery was confirmed with imaging (Figure 1B). Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP, with corresponding adjusted OR of 2.32 95% CI 1.07 – 5.06, OR 21.12 95% CI 6.49 – 129.75, and 18.93 95% CI 4.86 – 124.41, respectively. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery. Conclusion: After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.