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Type: Journal article
Title: Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study
Author: Sacher, F.
Monahan, K.
Thomas, S.
Davidson, N.
Adragao, P.
Sanders, P.
Hocini, M.
Takahashi, Y.
Rotter, M.
Rostock, T.
Hsu, L.
Clementy, J.
Haissaguerre, M.
Ross, D.
Packer, D.
Jais, P.
Citation: Journal of the American College of Cardiology, 2006; 47(12):2498-2503
Publisher: Elsevier Science Inc
Issue Date: 2006
ISSN: 0735-1097
Statement of
Frédéric Sacher, Kristi H. Monahan, Stuart P. Thomas, Neil Davidson, Pedro Adragao, Prashanthan Sanders, Mélèze Hocini, Yoshihide Takahashi, Martin Rotter, Thomas Rostock, Li-Fern Hsu, Jacques Clémenty, Michel Haïssaguerre, David L. Ross, Douglas L. Packer, Pierre Jaïs
Abstract: <h4>Objectives</h4>The purpose of this study was to characterize the occurrence of phrenic nerve injury (PNI) and its outcome after radiofrequency (RF) ablation of atrial fibrillation (AF).<h4>Background</h4>It is recognized that extra-myocardial damage may develop owing to penetration of ablative energy.<h4>Methods</h4>Between 1997 and 2004, 3,755 consecutive patients underwent AF ablation at five centers. Among them, 18 patients (0.48%; 9 male, 54 +/- 10 years) had PNI (16 right, 2 left). The procedure consisted of pulmonary vein (PV) isolation in 15 patients and anatomic circumferential ablation in 3 patients, with additional left atrial lesions (n = 11) and/or superior vena cava (SVC) disconnection (n = 4).<h4>Results</h4>Right PNI occurred during ablation of right superior PV (n = 12) or SVC disconnection (n = 3). Left PNI occurred during ablation at the left atrial appendage. Immediate features were dyspnea, cough, hiccup, and/or sudden diaphragmatic elevation in 9, and in the remaining the diagnosis was made after ablation owing to dyspnea (n = 7) or on routine radiographic evaluation (n = 2). Four patients (22%) were asymptomatic. Complete recovery occurred in 12 patients (66%). Recovery occurred within 24 h in the two patients with left PNI and in one patient with right PNI occurring with SVC disconnection. In the other nine patients, right PNI recovery occurred after 4 +/- 5 months (1 to 12 months) with respiratory rehabilitation. After a mean follow-up of 36 +/- 33 months, six patients have persistent PNI (three with partial and three with no recovery).<h4>Conclusions</h4>In this multicenter experience, PNI was a rare complication (0.48%) of AF ablation. Ablation of the right superior PV, SVC, and left atrial appendage were associated with PNI. Complete (66%) or partial (17%) recovery was observed in the majority.
Keywords: Phrenic Nerve; Humans; Atrial Fibrillation; Intraoperative Complications; Catheter Ablation; Adult; Aged; Middle Aged; Female; Male
Description: © 2006 American College of Cardiology Foundation
RMID: 0020071810
DOI: 10.1016/j.jacc.2006.02.050
Appears in Collections:Medicine publications

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