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Phrenic nerve palsy during right-sided pulmonary veins cryoapplications: new insights from pulmonary vein anatomy addressed by computed tomography

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

There is still sparse information regarding phrenic nerve palsy (PNP) during the cryoablation of both right-sided pulmonary vein (PV) and its anatomical predictors.

Methods

Consecutive patients who had undergone pulmonary vein isolation (PVI) using CB-A and suffered PNP during both right-sided PVs were retrospectively included in our study. Two other groups were then selected among patients who experienced PNP during RIPV application only (group 2) and RSPV application only (group 3).

Results

The incidence of PNI during both right-sided PVs cryoapplications was 2.1%, (32 of 1542 patients). There were no significant clinical differences between the 3 groups. Time from basal temperature to −40 °C significantly differed among the groups for both RIPV (p = 0.0026) and RSPV applications (p = 0.0382). Patients with PNP occurring during RSPV applications had significantly larger RSPV cross-sectional area compared to patients without PNP (p = 0.0116), while in patients with PNP during RIPV application, the angle of RIPV ostium on the transverse plane was significantly smaller compared to patients without PNP (p = 0.0035). The carina width was significantly smaller in patients with PNP occurring during both right-sided PVs cryoapplications compared to patients in which PNP occurred only during one right-sided PV application (p < 0.0001); a cutoff value of 8.5 mm had a sensitivity of 87.3% and a specificity of 75.0%.

Conclusion

PNP in both right-sided PVs applications is a complication that occurred in 2.1% of cases during CB-A. Pre-procedural evaluation of right PVs anatomy might be useful in evaluating the risk of PNP.

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Author information

Author notes

  1. Riccardo Maj and Gianluca Borio contributed equally to the work as co-first authors

Authors and Affiliations

  1. Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium

    Riccardo Maj, Gianluca Borio, Erwin Ströker, Juan Sieira, Alessandro Rizzo, Alessio Galli, Varnavas Varnavas, Maysam Al Housari, Dimitrios Sofianos, Shuichiro Kazawa, Muryo Terasawa, Gezim Bala, Federico Cecchini, Thiago Guimarães Osório, Pedro Brugada, Carlo De Asmundis & Gian Battista Chierchia

  2. Electrophysiology Unit, Villa Maria Cecilia, Via Corriera, 1, 48033, Cotignola, RA, Italy

    Saverio Iacopino

  3. Thoraxcentrum, Blekingesjukhuset, Karlskrona, Sweden

    Nicoleta Sora

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  1. Riccardo Maj
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Corresponding author

Correspondence to Riccardo Maj.

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Conflict of interest

Prof. de Asmundis, Prof Brugada, and Prof Chierchia have received consulting fees and speaker honoraria from Medtronic. G.B.C. and C. d A. have received compensation for teaching and proctoring purposes from AF solutions Medtronic.

Ethical approval

All procedures performed in the studies involving patients were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the present study.

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Maj, R., Borio, G., Ströker, E. et al. Phrenic nerve palsy during right-sided pulmonary veins cryoapplications: new insights from pulmonary vein anatomy addressed by computed tomography. J Interv Card Electrophysiol 60, 85–92 (2021). https://doi.org/10.1007/s10840-020-00713-1

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  • DOI: https://doi.org/10.1007/s10840-020-00713-1

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