Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation. Characterization and Outcome in a Multicenter Study

Frédéric Sacher, Kristi H. Monahan, Stuart P. Thomas, Neil Davidson, Pedro Adragao, Prashanthan Sanders, Mélèze Hocini, Yoshihide Takahashi, Martin Rotter, Thomas Rostock, Li Fern Hsu, Jacques Clémenty, Michel Haïssaguerre, David L. Ross, Douglas L. Packer, Pierre Jaïs

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241 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2498-2503
Number of pages6
JournalJournal of the American College of Cardiology
Volume47
Issue number12
DOIs
StatePublished - Jun 20 2006

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Sacher, F., Monahan, K. H., Thomas, S. P., Davidson, N., Adragao, P., Sanders, P., Hocini, M., Takahashi, Y., Rotter, M., Rostock, T., Hsu, L. F., Clémenty, J., Haïssaguerre, M., Ross, D. L., Packer, D. L., & Jaïs, P. (2006). Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation. Characterization and Outcome in a Multicenter Study. Journal of the American College of Cardiology, 47(12), 2498-2503. https://doi.org/10.1016/j.jacc.2006.02.050