title: Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon.
abstract: BACKGROUND
  Phrenic nerve palsy (PNP) is the most frequently observed complication during cryoballoon ablation (CB; Arctic Front, Medtronic, MN) occurring in roughly 7%-9% of the cases. The new second-generation cryoballoon ablation Arctic Front Advance (CB-A) (Arctic Front) has recently been launched in the market.
  
  
  OBJECTIVE
  To evaluate the incidence of right PNP with the new CB-A in comparison with the first-generation balloon in a series of consecutive patients that underwent pulmonary vein isolation with this modality.
  
  
  METHODS
  The study was designed as an observational study with a prospective follow-up. In total, 121 consecutive patients were included: 80 patients with the CB (group 1) and 41 with the CB-A (group 2).
  
  
  RESULTS
  Mean procedural times, fluoroscopic times, and time to pulmonary vein isolation documented by real-time recordings were significantly lower in group 2 (P ≤ .05). The occurrence of PNP was significantly higher in group 2 (6.25% [5 of 80] in group 1 vs 19.5% [8 of 41] in group 2; P = .033). At 7 months, PNP persisted in 1 (2.5%) patient in the CB-A group.
  
  
  CONCLUSIONS
  Right PNP seems to occur in a significantly larger number of patients with the second-generation CB-A. However, this complication is reversible in nearly all cases on short-term follow-up. More refined phrenic nerve monitoring during right-sided pulmonary vein ablation and less vigorous wedging maneuvers in the pulmonary vein ostia might significantly reduce the occurrence of this complication.
authors.affiliation: Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. rbcasado@gmail.com
authors.forename: Ruben
authors.initials: R
authors.lastname: Casado-Arroyo
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.forename: Moisés
authors.initials: M
authors.lastname: Levinstein
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira
authors.forename: Moises
authors.initials: M
authors.lastname: Rodriguez-Mañero
authors.forename: Giacomo
authors.initials: G
authors.lastname: di Giovanni
authors.forename: Yannis
authors.initials: Y
authors.lastname: Baltogiannis
authors.forename: Kristel
authors.initials: K
authors.lastname: Wauters
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.forename: Andrea
authors.initials: A
authors.lastname: Sarkozy
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D021721:Balloon Occlusion / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D010791:Phrenic Nerve / Q000293:injuries*; D011667:Pulmonary Veins / Q000601:surgery; D012189:Retrospective Studies
keywords: AAD; AF; Ablation; Atrial fibrillation; CB; CB-A; Complication; Cryoballoon; EGD; PN; PNP; PV; PVI; Phrenic nerve paralysis; Pulmonary vein isolation; RIPV; RSPV; SVC; antiarrhythmic drug treatment; atrial fibrillation; cryoballoon ablation; cryoballoon ablation Arctic Front Advance; esohagogastroduodenoscopy; phrenic nerve; phrenic nerve palsy; pulmonary vein; pulmonary vein isolation; right inferior pulmonary vein; right superior pulmonary vein; superior vena cava