Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis

Christian H. Heeger*, Sorin Stefan Popescu, Christian Sohns, Alexander Pott, Andreas Metzner, Osamu Inaba, Florian Straube, Malte Kuniss, Arash Aryana, Shinsuke Miyazaki, Serkan Cay, Joachim R. Ehrlich, Ibrahim El-Battrawy, Martin Martinek, Ardan M. Saguner, Verena Tscholl, Kivanc Yalin, Evgeny Lyan, Wilber Su, Giorgi PapiashviliMaichel Sobhy Naguib Botros, Alessio Gasperetti, Riccardo Proietti, Erik Wissner, Daniel Scherr, Masashi Kamioka, Hisaki Makimoto, Tsuyoshi Urushida, Tolga Aksu, Julian K.R. Chun, Kudret Aytemir, Ewa Jȩdrzejczyk-Patej, Karl Heinz Kuck, Tillman Dahme, Daniel Steven, Philipp Sommer, Roland Richard Tilz*

*Corresponding author for this work
3 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalEuropace
Volume25
Issue number2
Pages (from-to)374-381
Number of pages8
ISSN1099-5129
DOIs
Publication statusPublished - 01.02.2023

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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