title: Incidence and characteristics of phrenic nerve palsy following pulmonary vein isolation with the second-generation as compared with the first-generation cryoballoon in 360 consecutive patients.
abstract: OBJECTIVE
  The second-generation cryoballoon (CB2) with increased surface cooling has recently become available. The aim was to investigate the incidence and characteristics of phrenic nerve palsy (PNP) during pulmonary vein isolation (PVI) using the CB2 as compared with the first-generation balloon (CB1).
  
  
  RESULTS
  A total of 360 consecutive patients with atrial fibrillation underwent PVI with the CB1 (106 patients) or the CB2 (254 patients). Right PN function was monitored by continuous stimulation and palpation during septal PV ablation. Persistent PNP (present at discharge) occurred in 2.8 and 1.9% (P = 0.63) of patients, transient PNP (full recovery before discharge) in 5.9 and 3.8% (P = 0.41) of patients in the CB2 and CB1 group, respectively. Phrenic nerve palsy during ablation at the right inferior PV was observed in 0% (CB1) and 4.3% (CB2, P = 0.03) of patients. Using the CB2, a trend of reduced incidence of persistent PNP over quartiles of consecutive patients was observed [4.8% (Q1) vs. 0% (Q4); P = 0.077]. At the culprit PV, PNP occurred after 3.5 ± 2.1 (CB1) and 1.1 ± 0.4 applications (CB2; P = 0.036). Complete recovery of PN function occurred after 29 ± 11 (CB1) and 259 ± 137 days (CB2; P = 0.004).
  
  
  CONCLUSIONS
  The rate of transient/persistent PNP associated with the use of the CB2 was 5.9 and 2.8%, respectively. Time to restitution of PN function was longer using the CB2.
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany a.fuernkranz@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dugo
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: De Lazzari
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Schulte-Hahn
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Nowak
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, D-60431 Frankfurt a.M, Germany.
authors.forename: Julian K R
authors.initials: JK
authors.lastname: Chun
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000706:statistics & numerical data; D015897:Comorbidity; D003452:Cryosurgery / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology; D011667:Pulmonary Veins / Q000601:surgery*; D012133:Respiratory Paralysis / Q000453:epidemiology*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ablation; Arrhythmia; Atrial fibrillation; Balloon; Phrenic nerve