TY - JOUR
T1 - Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates
T2 - a YETI subgroup analysis
AU - Heeger, Christian H.
AU - Popescu, Sorin Stefan
AU - Sohns, Christian
AU - Pott, Alexander
AU - Metzner, Andreas
AU - Inaba, Osamu
AU - Straube, Florian
AU - Kuniss, Malte
AU - Aryana, Arash
AU - Miyazaki, Shinsuke
AU - Cay, Serkan
AU - Ehrlich, Joachim R.
AU - El-Battrawy, Ibrahim
AU - Martinek, Martin
AU - Saguner, Ardan M.
AU - Tscholl, Verena
AU - Yalin, Kivanc
AU - Lyan, Evgeny
AU - Su, Wilber
AU - Papiashvili, Giorgi
AU - Botros, Maichel Sobhy Naguib
AU - Gasperetti, Alessio
AU - Proietti, Riccardo
AU - Wissner, Erik
AU - Scherr, Daniel
AU - Kamioka, Masashi
AU - Makimoto, Hisaki
AU - Urushida, Tsuyoshi
AU - Aksu, Tolga
AU - Chun, Julian K.R.
AU - Aytemir, Kudret
AU - Jȩdrzejczyk-Patej, Ewa
AU - Kuck, Karl Heinz
AU - Dahme, Tillman
AU - Steven, Daniel
AU - Sommer, Philipp
AU - Tilz, Roland Richard
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Aims: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. Methods and results: In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. Conclusion: In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.
AB - Aims: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. Methods and results: In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. Conclusion: In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.
UR - http://www.scopus.com/inward/record.url?scp=85148307329&partnerID=8YFLogxK
U2 - 10.1093/europace/euac212
DO - 10.1093/europace/euac212
M3 - Journal articles
C2 - 36414239
AN - SCOPUS:85148307329
SN - 1099-5129
VL - 25
SP - 374
EP - 381
JO - Europace
JF - Europace
IS - 2
ER -
