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Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.

Abstract：

OBJECTIVES:The purpose of this study was to characterize the occurrence of phrenic nerve injury (PNI) and its outcome after radiofrequency (RF) ablation of atrial fibrillation (AF). BACKGROUND:It is recognized that extra-myocardial damage may develop owing to penetration of ablative energy. METHODS:Between 1997 and 2004, 3,755 consecutive patients underwent AF ablation at five centers. Among them, 18 patients (0.48%; 9 male, 54 +/- 10 years) had PNI (16 right, 2 left). The procedure consisted of pulmonary vein (PV) isolation in 15 patients and anatomic circumferential ablation in 3 patients, with additional left atrial lesions (n = 11) and/or superior vena cava (SVC) disconnection (n = 4). RESULTS:Right PNI occurred during ablation of right superior PV (n = 12) or SVC disconnection (n = 3). Left PNI occurred during ablation at the left atrial appendage. Immediate features were dyspnea, cough, hiccup, and/or sudden diaphragmatic elevation in 9, and in the remaining the diagnosis was made after ablation owing to dyspnea (n = 7) or on routine radiographic evaluation (n = 2). Four patients (22%) were asymptomatic. Complete recovery occurred in 12 patients (66%). Recovery occurred within 24 h in the two patients with left PNI and in one patient with right PNI occurring with SVC disconnection. In the other nine patients, right PNI recovery occurred after 4 +/- 5 months (1 to 12 months) with respiratory rehabilitation. After a mean follow-up of 36 +/- 33 months, six patients have persistent PNI (three with partial and three with no recovery). CONCLUSIONS:In this multicenter experience, PNI was a rare complication (0.48%) of AF ablation. Ablation of the right superior PV, SVC, and left atrial appendage were associated with PNI. Complete (66%) or partial (17%) recovery was observed in the majority.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Sacher F,Monahan KH,Thomas SP,Davidson N,Adragao P,Sanders P,Hocini M,Takahashi Y,Rotter M,Rostock T,Hsu LF,Clémenty J,Haïssaguerre M,Ross DL,Packer DL,Jaïs P

doi

10.1016/j.jacc.2006.02.050

subject

Has Abstract

pub_date

2006-06-20 00:00:00

pages

2498-503

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(06)00863-1

journal_volume

pub_type

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Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study.