Cryoballoon ablation was associated with a higher incidence of phrenic nerve palsy compared to laser balloon ablation (4.2% vs 1.5%, P=0.003), although most cases were transient.
Cohort (n=2,433)
Does cryoballoon ablation compared to laser balloon ablation affect the incidence and recovery course of phrenic nerve palsy in patients undergoing atrial fibrillation ablation?
While cryoballoon ablation has a higher overall incidence of phrenic nerve palsy compared to laser balloon ablation, the majority are transient, whereas laser balloon ablation is associated with more persistent nerve injury requiring longer recovery.
Absolute Event Rate: 4.2% vs 1.5%
p-value: p=.003
AIMS: Systematic data on phrenic nerve palsy (PNP) associated with contemporary balloon ablation techniques (cryoballoon CBA vs laser balloon LBA) are sparse. We aimed to investigate the incidence, characteristics, and clinical recovery course in patients with PNP who underwent CBA or LBA. METHODS AND RESULTS: A total of 2433 consecutive patients who underwent balloon-based pulmonary vein isolation (CBA: n = 1720 and LBA: n = 713) were retrospectively identified. PNP was classified into (a) transient (recovery before discharge) or (b) persistent (within 6 months, 6-12 months, and >12 months) according to clinical recovery course. In general, PNP occurred significantly more often in CBA 71/1720 (4.2%) than LBA 11/713 (1.5%) (P = .003). The rate of transient PNP was significantly higher in CBA (3.0%, n = 45) than LBA (0.1%, n = 1, P = .004). The rate of persistent PNP did not significantly differ between two groups (CBA: 1.2% vs LBA: 1.4%, P = .89). The rate of persistent PNP which recovered within 6 months was similar (CBA: 17.4% vs LBA 18.2%, P = 1.000). However, the rates of persistent PNP which recovered within 6 to 12 months (CBA: 2.9% vs LBA 27.3%, P = .0171) and more than 12 months (CBA: 7.3% vs LBA 45.5%, P = .0034) were significantly higher in LBA. CONCLUSION: PNP occurred more often in CBA than LBA, however, the majority of PNP in CBA was transient whereas the majority of PNP in LBA was persistent. Either balloon technology is not superior in terms of long-term PNP.
Tohoku et al. (2020) conducted a cohort in Atrial fibrillation (n=2,433). Cryoballoon ablation vs. Laser balloon ablation was evaluated on Incidence of phrenic nerve palsy (PNP) (p=.003). Cryoballoon ablation was associated with a higher incidence of phrenic nerve palsy compared to laser balloon ablation (4.2% vs 1.5%, P=0.003), although most cases were transient.