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

• Published in: Europace (London, England) England), 2023-02, Vol.25 (2), p.374-381
• Main Authors: Heeger, Christian-H, Popescu, Sorin Ștefan, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R, El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M, Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K R, Aytemir, Kudret, Jędrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, Tilz, Roland Richard
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Catheter Ablation - adverse effects; Clinical Research; Cryosurgery - adverse effects; Cryosurgery - methods; Humans; Phrenic Nerve; Pulmonary Veins - surgery; Recurrence; Time Factors; Treatment Outcome
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac212

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. 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. 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. https://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.