title: Persistence of Phrenic Nerve Palsy Following 28-mm Cryoballoon Ablation: A Four-Year Single Center Experience.
abstract: BACKGROUND
  Phrenic nerve palsy (PNP) is the most frequently observed complication in the setting of cryoballoon (CB) ablation (Arctic Front, Medtronic Inc., Minneapolis, MN, USA). Although, usually transient, resolving before the end of the procedure, persistent PNP (not resolving before the end of procedure) can occur. Literature on persistent PNP after second generation CB ablation is relatively sparse.
  
  
  METHODS
  A total of 316 consecutive patients having undergone large 28-mm CB ablation as index procedure in the Heart Rhythm Management Center, UZ Brussels, Belgium, from January 2009 to December 2013 were retrospectively reviewed for the study. Of these 117 patients were treated with the first generation CB (CB1) and 199 patients with the second generation CB (CB2).
  
  
  RESULTS
  PNP occurred in 10% of the total population. Persistent PNP was only observed following CB2 ablation which occurred in 4.5% of the group. At a mean follow-up of 11 months, diaphragmatic contraction in persistent PNP patients resumed in 78% (7/9) of the patients. In a final follow-up at 5 and 20 months, PNP persisted in two patients, respectively. PNP during ablation in the right inferior pulmonary vein was only observed in the CB2 group. No predictors of persistency of PNP were observed.
  
  
  CONCLUSIONS
  Persistence of PNP only occurred in the CB2 group in 4.5% of patients. The majority of patients with persistent PNP were asymptomatic. In most of the patients having persistent PNP after ablation, complete phrenic nerve function resumed during follow-up (78%).
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Yukio
authors: Y
authors: Saitoh
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Ghazala
authors: G
authors: Irfan
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Giuseppe
authors: G
authors: Ciconte
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Giacomo
authors: G
authors: Mugnai
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Juan
authors: J
authors: Sieira
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Giacomo
authors: G
authors: Di Giovanni
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Giannis
authors: G
authors: Baltogiannis
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Giulio
authors: G
authors: Conte
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Burak
authors: B
authors: Hünük
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Erwin
authors: E
authors: Ströker
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Vedran
authors: V
authors: Velagić
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Ingrid
authors: I
authors: Overeinder
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Carlo
authors: C
authors: De Asmundis
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Gian-Battista
authors: GB
authors: Chierchia
authors: From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
authors: Pedro
authors: P
authors: Brugada
mesh_terms: D001530:Belgium / Q000453:epidemiology; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D003452:Cryosurgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000601:surgery; D010791:Phrenic Nerve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012133:Respiratory Paralysis / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; cryoballoon; phrenic nerve palsy