Abstract
This study aimed to evaluate the incidence and pre-procedural predictors of right phrenic nerve injury (PNI) in electromyography-guided, second-generation cryoballoon (CB) ablation. Second-generation CBs perform better pulmonary vein isolation (PVI) than first-generation CBs; however, right PNI remains a concern. One hundred consecutive patients with paroxysmal atrial fibrillation who underwent cryoablation were prospectively enrolled. Contrast-enhanced cardiac multidetector computed tomography (MDCT) was obtained pre-procedurally. PVI was performed with one 28-mm second-generation balloon using a 3-min freeze technique under electromyography guidance. In all, 377 of 392 (96.2%) PVs were isolated using a CB. In 9 (9.0%) patients, right PNI was observed during the ablation of the right superior PV (RSPV). All events occurred during freezing, except for 1 that occurred during thawing. Right peri-cardiophrenic bundles (RPCBs) were identified at the level of the RSPV on MDCT in 97 patients. In the logistic regression analysis, the distance from the RSPV ostium to the RPCBs (hazard ratio: 0.263; 95% confidence interval [CI]: 0.110 to 0.630; p = 0.003) was the sole predictor of PNI. The optimal cutoff point for the distance for predi...Continue Reading
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