Phrenic nerve injury in atrial fibrillation ablation using balloon catheters: Incidence, characteristics and clinical recovery course.

AIMS: Systematic data on phrenic nerve palsy (PNP) associated with contemporary balloon ablation techniques (cryoballoon, CBA, vs. laserballoon, LBA) is sparse. We aimed to investigate the incidence, characteristics and clinical recovery course in patients with PNP who underwent CBA or LBA. METHODS AND RESULTS: A total of 2433 consecutive patients who underwent balloon-based pulmonary vein isolation (CBA: n = 1720, LBA: n = 713) were retrospectively identified. PNP was classified into 1) transient (recovery before discharge) or 2) persistent (within 6 months, 6-12 months, more than 12 months) according to clinical recovery course. In general, PNP occurred significantly more often in CBA 71/1720 (4.2%) than LBA 11/713 (1.5%) (P = 0.003). The rate of transient PNP was significantly higher in CBA (3.0%, n = 45) than LBA (0.1%, n = 1, P = 0.004). The rate of persistent PNP did not significantly differ between two groups (CBA: 1.2% vs. LBA: 1.4%, P = 0.89). The rate of persistent PNP which recovered within 6 months was similar (CBA: 17.4% vs. LBA 18.2%, P =1.000). However, the rates of persistent PNP which recovered 6-12 months (CBA: 2.9% vs. LBA 27.3%, P = 0.0171) and more than after 12 months (CBA: 7.3% vs. LBA 45.5%, P = 0.0034) were significantly higher in LBA. CONCLUSION: PNP occurred more often in CBA than LBA, however, the majority of PNP in CBA was transient whereas the majority of PNP in LBA was persistent. Either balloon technology is not superior in terms of long-term PNP. This article is protected by copyright. All rights reserved.