Key result
Premature cryoballoon abortion for phrenic nerve injury yields ~25% pulmonary vein reconnection at repeat ablation.
Why the study?
Phrenic nerve injury is the most frequent complication during cryoballoon-based PVI leading to premature freeze abortion, but its impact on pulmonary vein reconnection rates during repeat procedures required evaluation in a large-scale population.
Cohort (n=89)
Yes
Premature termination of cryoballoon ablation due to phrenic nerve injury still results in durable pulmonary vein isolation in over 75% of patients, particularly when a rapid initial temperature drop is achieved.
Answers are grounded in this paper and cite their sources.
Early phrenic nerve injury abortion supports durable isolation in most cases; leaves open randomized comparison to uninterrupted applications.
AIMS: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. METHODS AND RESULTS: In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. CONCLUSION: In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.
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Heeger et al. (2022) conducted a cohort in Atrial fibrillation with prior cryoballoon ablation complicated by phrenic nerve injury (n=89). Premature abortion of cryoballoon freeze cycle due to phrenic nerve injury was evaluated on Pulmonary vein electrical reconnection rate during repeat procedure. In patients with premature cryoballoon application abortion due to phrenic nerve injury, the pulmonary vein electrical reconnection rate was 24.7% during repeat procedures for recurrent atrial fibrillation.
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