Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.
OBJECTIVE
The purpose of this study was to characterize the occurrence of phrenic nerve injury (PNI) and its outcome after radiofrequency (RF) ablation of atrial fibrillation (AF).


BACKGROUND
It is recognized that extra-myocardial damage may develop owing to penetration of ablative energy.


METHODS
Between 1997 and 2004, 3,755 consecutive patients underwent AF ablation at five centers. Among them, 18 patients (0.48%; 9 male, 54 +/- 10 years) had PNI (16 right, 2 left). The procedure consisted of pulmonary vein (PV) isolation in 15 patients and anatomic circumferential ablation in 3 patients, with additional left atrial lesions (n = 11) and/or superior vena cava (SVC) disconnection (n = 4).


RESULTS
Right PNI occurred during ablation of right superior PV (n = 12) or SVC disconnection (n = 3). Left PNI occurred during ablation at the left atrial appendage. Immediate features were dyspnea, cough, hiccup, and/or sudden diaphragmatic elevation in 9, and in the remaining the diagnosis was made after ablation owing to dyspnea (n = 7) or on routine radiographic evaluation (n = 2). Four patients (22%) were asymptomatic. Complete recovery occurred in 12 patients (66%). Recovery occurred within 24 h in the two patients with left PNI and in one patient with right PNI occurring with SVC disconnection. In the other nine patients, right PNI recovery occurred after 4 +/- 5 months (1 to 12 months) with respiratory rehabilitation. After a mean follow-up of 36 +/- 33 months, six patients have persistent PNI (three with partial and three with no recovery).


CONCLUSIONS
In this multicenter experience, PNI was a rare complication (0.48%) of AF ablation. Ablation of the right superior PV, SVC, and left atrial appendage were associated with PNI. Complete (66%) or partial (17%) recovery was observed in the majority.
Sacher
Frédéric
F
Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
Monahan
Kristi H
KH
Thomas
Stuart P
SP
Davidson
Neil
N
Adragao
Pedro
P
Sanders
Prashanthan
P
Hocini
Mélèze
M
Takahashi
Yoshihide
Y
Rotter
Martin
M
Rostock
Thomas
T
Hsu
Li-Fern
LF
Clémenty
Jacques
J
Haïssaguerre
Michel
M
Ross
David L
DL
Packer
Douglas L
DL
Jaïs
Pierre
P
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries*