Abstract 126 Predictors of phrenic nerve injury recovery after cryoballoon based pulmonary vein isolation: The worldwide YETI registry

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Predictors of phrenic nerve injury recovery after cryoballoon based pulmonary vein isolation: The worldwide YETI registry
C.-H. Heeger¹, C. Sohns², A. Pott³, A. Metzner⁴, F. Straube⁵, M. Kuniss⁶, J. Ehrlich⁷, I. El-Battrawy⁸, A. Saguner⁹, V. Tscholl¹⁰, E. Lyan¹¹, H. Makimoto¹², K. R. J. Chun¹³, K.-H. Kuck¹⁴, T. Dahme³, D. Steven¹⁵, P. Sommer¹⁶, R. R. Tilz¹, für die Studiengruppen: YETI
¹Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Elektrophysiologie/ Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ³Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm; ⁴Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ⁵Klinik für Kardiologie und Internistische Intensivmedizin, München Klinik Bogenhausen, München; ⁶Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; ⁷Medizinische Klinik I, St. Josefs Hospital, Wiesbaden; ⁸I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; ⁹Universitätsspital, Zürich, CH; ¹⁰CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; ¹¹Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen; ¹²Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; ¹³Medizinische Klinik III - CCB, Agaplesion Markus Krankenhaus, Frankfurt am Main; ¹⁴Kardiologie, LANS Cardio Hamburg, Hamburg; ¹⁵Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln; ¹⁶Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;
Aims: Cryoballoon (CB) based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI). However, data on PNI especially of recovery is scarce. We aimed to evaluate the prognosis and outcomes of PNI during second (CB2), third (CB3) or fourth (CB4) generation CB based-PVI in a large-scale population. Methods and Results: A total of 17356 patients underwent CB based-PVI in 33 centers. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4s 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, CB temperature at PNI and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on this 5 parameters the YETI score was calculated. The YETI score directly gives the probability of PNI recovery within 12 months. Conclusion: The incidence of PNI during CB-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after CB-based PVI. The YETI score estimates the prognosis after iatrogenic CB-derived PNI.
https://dgk.org/kongress_programme/ht2021/P523.htm