ArticleFrontiers in cardiovascular medicine2025
Phrenic nerve palsy during cryoballoon ablation of atrial fibrillation: a minor complication or a wolf in sheep's clothing? Insights on late arrhythmia recurrences from a propensity score-matched analysis.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Clinical outcomes after catheter ablation for atrial fibrillation in elderly patients: a meta-analysis with time-to-event data reconstruction.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Review
- [Late complications after atrial fibrillation ablation : Diagnosis and management].Herzschrittmachertherapie & Elektrophysiologie · 2026Review
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15 authors.
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Abstract
Background: Pulmonary vein isolation (PVI) has become the cornerstone of percutaneous atrial fibrillation (AF) treatment, and cryoballoon ablation (CB-A) has been shown to be non-inferior to radiofrequency (RF) ablation in terms of safety and efficacy. Hemi diaphragmatic paralysis, secondary to right phrenic nerve palsy (PNP), is the most common complication associated with cryoballoon ablation, occurring in 1.1%-6.2% of procedures. Although, in the literature, PNP appears to not jeopardize the acute electrical isolation of the right-sided pulmonary veins, its occurrence forces the electrophysiologist to immediately stop cryoenergy delivery, thus resulting in a shorter cryo-application time. Aims: The purpose of the analysis is to understand whether the occurrence of intraprocedural PNP can be related to an increased risk of developing atrial fibrillation/atrial flutter (AT/AF) recurrences during the follow-up. Methods and results: We retrospectively enrolled 116 consecutive patients who experienced PNP during PVI using the second-generation cryoballoon. This group was compared using 1:1 propensity score (PS) and caliper matching with a cohort of patients who did not present PNP. After the matching, 108 patients with CB-A related phrenic nerve palsy (PNP+ group) were analyzed and compared with 108 patients who did not experienced PNP (PNP- group). After a median follow-up of 19 [12.0, 31.0] months, the success rate was significantly lower in the PNP+ group compared to the control group (57.4% vs. 78.7%, Log-Rank Conclusions: The present study showed that PNP, although typically reversible and without long-term sequelae, is associated with a significantly lower success rate of CB-A PVI and a higher risk of arrhythmia recurrences.
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