Heeger, Christian-H, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan et al (show 26 more authors)
(2022)
Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry.
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 15 (1).
pp. 23-32.
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Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation Results of the Worldwide YETI Registry.pdf - Published version Download (603kB) | Preview |
Abstract
<h4>Background</h4>Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.<h4>Methods</h4>The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.<h4>Results</h4>A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.<h4>Conclusions</h4>The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | atrial fibrillation, catheter ablation, cryoballoon, incidence, phrenic nerve injury |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 13 May 2022 14:43 |
| Last Modified: | 18 Jan 2023 21:03 |
| DOI: | 10.1161/CIRCEP.121.010516 |
| Open Access URL: | https://www.ahajournals.org/doi/10.1161/CIRCEP.121... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3154756 |
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