Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry
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Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry. / Heeger, Christian-H; Sohns, Christian; Pott, Alexander; Metzner, Andreas; Inaba, Osamu; Straube, Florian; Kuniss, Malte; Aryana, Arash; Miyazaki, Shinsuke; Cay, Serkan; Ehrlich, Joachim R; El-Battrawy, Ibrahim; Martinek, Martin; Saguner, Ardan M; Tscholl, Verena; Yalin, Kivanc; Lyan, Evgeny; Su, Wilber; Papiashvili, Giorgi; Botros, Maichel Sobhy Naguib; Gasperetti, Alessio; Proietti, Riccardo; Wissner, Erik; Scherr, Daniel; Kamioka, Masashi; Makimoto, Hisaki; Urushida, Tsuyoshi; Aksu, Tolga; Chun, Julian K R; Aytemir, Kudret; Jędrzejczyk-Patej, Ewa; Kuck, Karl-Heinz; Dahme, Tillman; Steven, Daniel; Sommer, Philipp; Richard Tilz, Roland.
in: CIRC-ARRHYTHMIA ELEC, Jahrgang 15, Nr. 1, e010516, 01.2022.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry
AU - Heeger, Christian-H
AU - Sohns, Christian
AU - Pott, Alexander
AU - Metzner, Andreas
AU - Inaba, Osamu
AU - Straube, Florian
AU - Kuniss, Malte
AU - Aryana, Arash
AU - Miyazaki, Shinsuke
AU - Cay, Serkan
AU - Ehrlich, Joachim R
AU - El-Battrawy, Ibrahim
AU - Martinek, Martin
AU - Saguner, Ardan M
AU - Tscholl, Verena
AU - Yalin, Kivanc
AU - Lyan, Evgeny
AU - Su, Wilber
AU - Papiashvili, Giorgi
AU - Botros, Maichel Sobhy Naguib
AU - Gasperetti, Alessio
AU - Proietti, Riccardo
AU - Wissner, Erik
AU - Scherr, Daniel
AU - Kamioka, Masashi
AU - Makimoto, Hisaki
AU - Urushida, Tsuyoshi
AU - Aksu, Tolga
AU - Chun, Julian K R
AU - Aytemir, Kudret
AU - Jędrzejczyk-Patej, Ewa
AU - Kuck, Karl-Heinz
AU - Dahme, Tillman
AU - Steven, Daniel
AU - Sommer, Philipp
AU - Richard Tilz, Roland
PY - 2022/1
Y1 - 2022/1
N2 - BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.METHODS: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.RESULTS: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.CONCLUSIONS: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
AB - BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.METHODS: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.RESULTS: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.CONCLUSIONS: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
U2 - 10.1161/CIRCEP.121.010516
DO - 10.1161/CIRCEP.121.010516
M3 - SCORING: Journal article
C2 - 34962134
VL - 15
JO - CIRC-ARRHYTHMIA ELEC
JF - CIRC-ARRHYTHMIA ELEC
SN - 1941-3149
IS - 1
M1 - e010516
ER -