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Heeger, CH; Popescu, SȘ; Sohns, C; Pott, A; Metzner, A; Inaba, O; Straube, F; Kuniss, M; Aryana, A; Miyazaki, S; Cay, S; Ehrlich, JR; El-Battrawy, I; Martinek, M; Saguner, AM; Tscholl, V; Yalin, K; Lyan, E; Su, W; Papiashvili, G; Botros, MSN; Gasperetti, A; Proietti, R; Wissner, E; Scherr, D; Kamioka, M; Makimoto, H; Urushida, T; Aksu, T; Chun, JKR; Aytemir, K; Jędrzejczyk-Patej, E; Kuck, KH; Dahme, T; Steven, D; Sommer, P; Tilz, RR.
Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis.
Europace. 2023; 25(2):374-381 Doi: 10.1093/europace/euac212 [OPEN ACCESS]
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Scherr Daniel

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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.

Find related publications in this database (using NLM MeSH Indexing)

Humans - administration & dosage

Atrial Fibrillation - diagnosis, surgery, etiology

Catheter Ablation - adverse effects

Cryosurgery - adverse effects, methods

Phrenic Nerve - administration & dosage

Pulmonary Veins - surgery

Recurrence - administration & dosage

Time Factors - administration & dosage

Treatment Outcome - administration & dosage

Find related publications in this database (Keywords)

Atrial fibrillation

Cryoballoon

Catheter ablation

Phrenic nerve injury

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