TY - JOUR
T1 - Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation. Characterization and Outcome in a Multicenter Study
AU - Sacher, Frédéric
AU - Monahan, Kristi H.
AU - Thomas, Stuart P.
AU - Davidson, Neil
AU - Adragao, Pedro
AU - Sanders, Prashanthan
AU - Hocini, Mélèze
AU - Takahashi, Yoshihide
AU - Rotter, Martin
AU - Rostock, Thomas
AU - Hsu, Li Fern
AU - Clémenty, Jacques
AU - Haïssaguerre, Michel
AU - Ross, David L.
AU - Packer, Douglas L.
AU - Jaïs, Pierre
PY - 2006/6/20
Y1 - 2006/6/20
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jacc.2006.02.050
DO - 10.1016/j.jacc.2006.02.050
M3 - Article
C2 - 16781380
AN - SCOPUS:33744971593
SN - 0735-1097
VL - 47
SP - 2498
EP - 2503
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -