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Highlights potential underreporting of phrenic nerve injury during pulsed field ablation for atrial fibrillation, suggesting the need for systematic nerve monitoring.
We read with great interest the comprehensive review by Sugrue and colleagues.1 Pulsed field ablation (PFA) is a promising, nonthermal energy allowing efficient pulmonary vein isolation during atrial fibrillation catheter ablation. However, uncertainties persist regarding the impact of PFA on right phrenic nerve (PN) function, with a subsequent risk of PN stunning (ie, transient) or palsy (ie, persistent). Indeed, data from the recently published MANIFEST-17K (Multi-National Survey on the Safety of the Post-Approval Clinical Use of Pulsed Field Ablation in 17,000+ Patients) registry found a low incidence (0.06%) of PN palsy,2 but such a complication might have been overlooked by the retrospective design of the study and the absence of systematic PN function monitoring during PFA procedures.
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Ollitrault et al. (2024) studied this question.
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