title: Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.
abstract: 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.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Kristi H
authors.initials: KH
authors.lastname: Monahan
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Thomas
authors.forename: Neil
authors.initials: N
authors.lastname: Davidson
authors.forename: Pedro
authors.initials: P
authors.lastname: Adragao
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
mesh_terms: 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*