Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation

Background Persistent phrenic nerve palsy is the most frequent complication of cryoballoon ablation for atrial fibrillation and can be disabling. Objectives To describe a technique—immediate balloon deflation (IBD)—for the prevention of persistent phrenic nerve palsy, provide data for its use, and d...

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Veröffentlicht in:Heart rhythm 2013-05, Vol.10 (5), p.646-652
Hauptverfasser: Ghosh, Justin, MBBS, Sepahpour, Ali, MBBS, Chan, Kim H., MBBS, Singarayar, Suresh, MBBS, PhD, McGuire, Mark A., MBBS, PhD
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container_end_page 652
container_issue 5
container_start_page 646
container_title Heart rhythm
container_volume 10
creator Ghosh, Justin, MBBS
Sepahpour, Ali, MBBS
Chan, Kim H., MBBS
Singarayar, Suresh, MBBS, PhD
McGuire, Mark A., MBBS, PhD
description Background Persistent phrenic nerve palsy is the most frequent complication of cryoballoon ablation for atrial fibrillation and can be disabling. Objectives To describe a technique—immediate balloon deflation (IBD)—for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary vein. Methods Cryoballoon procedures for atrial fibrillation were analyzed retrospectively (n = 130). IBD was performed in patients developing phrenic nerve dysfunction (n = 22). In vitro simulations were performed by using phantoms. Results No adverse events occurred, and all patients recovered normal phrenic nerve function before leaving the procedure room. No patient developed persistent phrenic nerve palsy. The mean cryoablation time to onset of phrenic nerve dysfunction was 144±64 seconds. Transient phrenic nerve dysfunction was seen more frequently with the 23-mm balloon than with the 28-mm balloon (11 of 39 cases vs 11 of 81 cases; P = .036). Balloon rewarming was faster following IBD. The time to return to 0 and 20° C was shorter in the IBD group (6.7 vs 8.9 seconds; P = .007 and 16.7 vs 37.6 seconds; P
doi_str_mv 10.1016/j.hrthm.2013.01.011
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Objectives To describe a technique—immediate balloon deflation (IBD)—for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary vein. Methods Cryoballoon procedures for atrial fibrillation were analyzed retrospectively (n = 130). IBD was performed in patients developing phrenic nerve dysfunction (n = 22). In vitro simulations were performed by using phantoms. Results No adverse events occurred, and all patients recovered normal phrenic nerve function before leaving the procedure room. No patient developed persistent phrenic nerve palsy. The mean cryoablation time to onset of phrenic nerve dysfunction was 144±64 seconds. Transient phrenic nerve dysfunction was seen more frequently with the 23-mm balloon than with the 28-mm balloon (11 of 39 cases vs 11 of 81 cases; P = .036). Balloon rewarming was faster following IBD. The time to return to 0 and 20° C was shorter in the IBD group (6.7 vs 8.9 seconds; P = .007 and 16.7 vs 37.6 seconds; P &lt;.0001). In vitro simulations confirmed that IBD caused more rapid tissue warming (time to 0°C, 14.0±3.4 seconds vs 46.0±8.1; P = .0001) and is unlikely to damage the atrium or pulmonary vein. Conclusions IBD results in more rapid tissue rewarming, causes no adverse events, and appears to prevent persistent phrenic nerve palsy. Simulations suggest that IBD is unlikely to damage the atrium or pulmonary vein.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2013.01.011</identifier><identifier>PMID: 23333737</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ablation ; Adult ; Aged ; Atrial fibrillation ; Atrial Fibrillation - surgery ; Cardiovascular ; Cryoballoon ; Cryosurgery - adverse effects ; Cryosurgery - methods ; Female ; Heart Atria - surgery ; Humans ; Male ; Middle Aged ; Paralysis - etiology ; Paralysis - prevention &amp; control ; Paralysis - surgery ; Phrenic Nerve - injuries ; Phrenic Nerve - surgery ; Phrenic nerve palsy ; Postoperative Complications - prevention &amp; control ; Pulmonary Veins - surgery ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Heart rhythm, 2013-05, Vol.10 (5), p.646-652</ispartof><rights>Heart Rhythm Society</rights><rights>2013 Heart Rhythm Society</rights><rights>Copyright © 2013 Heart Rhythm Society. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-5df5a312837bebc66bbae4639cb6dc3c63ce7308ab60dec918e360a5ba0805d03</citedby><cites>FETCH-LOGICAL-c480t-5df5a312837bebc66bbae4639cb6dc3c63ce7308ab60dec918e360a5ba0805d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S154752711300012X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23333737$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghosh, Justin, MBBS</creatorcontrib><creatorcontrib>Sepahpour, Ali, MBBS</creatorcontrib><creatorcontrib>Chan, Kim H., MBBS</creatorcontrib><creatorcontrib>Singarayar, Suresh, MBBS, PhD</creatorcontrib><creatorcontrib>McGuire, Mark A., MBBS, PhD</creatorcontrib><title>Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Persistent phrenic nerve palsy is the most frequent complication of cryoballoon ablation for atrial fibrillation and can be disabling. Objectives To describe a technique—immediate balloon deflation (IBD)—for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary vein. Methods Cryoballoon procedures for atrial fibrillation were analyzed retrospectively (n = 130). IBD was performed in patients developing phrenic nerve dysfunction (n = 22). In vitro simulations were performed by using phantoms. Results No adverse events occurred, and all patients recovered normal phrenic nerve function before leaving the procedure room. No patient developed persistent phrenic nerve palsy. The mean cryoablation time to onset of phrenic nerve dysfunction was 144±64 seconds. Transient phrenic nerve dysfunction was seen more frequently with the 23-mm balloon than with the 28-mm balloon (11 of 39 cases vs 11 of 81 cases; P = .036). Balloon rewarming was faster following IBD. The time to return to 0 and 20° C was shorter in the IBD group (6.7 vs 8.9 seconds; P = .007 and 16.7 vs 37.6 seconds; P &lt;.0001). In vitro simulations confirmed that IBD caused more rapid tissue warming (time to 0°C, 14.0±3.4 seconds vs 46.0±8.1; P = .0001) and is unlikely to damage the atrium or pulmonary vein. Conclusions IBD results in more rapid tissue rewarming, causes no adverse events, and appears to prevent persistent phrenic nerve palsy. Simulations suggest that IBD is unlikely to damage the atrium or pulmonary vein.</description><subject>Ablation</subject><subject>Adult</subject><subject>Aged</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiovascular</subject><subject>Cryoballoon</subject><subject>Cryosurgery - adverse effects</subject><subject>Cryosurgery - methods</subject><subject>Female</subject><subject>Heart Atria - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Paralysis - etiology</subject><subject>Paralysis - prevention &amp; control</subject><subject>Paralysis - surgery</subject><subject>Phrenic Nerve - injuries</subject><subject>Phrenic Nerve - surgery</subject><subject>Phrenic nerve palsy</subject><subject>Postoperative Complications - prevention &amp; control</subject><subject>Pulmonary Veins - surgery</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsGO1DAMjRCI3R34AiSUI5cOdjNNOweQ0GphV1qJAyBxi5LUZTK0SUnakXrnw8nsDHvgQmQptuXnJz-bsVcIawSUb_frXZx2w7oEFGvAbPiEXWJVyUI0NT49-pu6qMoaL9hVSnuAcitBPGcXpcivFvUl-303DNQ6PRE3uu9D8LylrteTy14XIh8jHcg_hKHjI8Xk0pQTfNxF8s5yT_FAfNR9Wng7R-d_8HHuh-B1XPiBnOcuhXNDszyy2LgEbU75F-xZl_H08vyv2LePN1-vb4v7z5_urj_cF3bTwFRUbVdpgWUjakPGSmmMpo0UW2tka4WVwlItoNFGQkt2iw0JCboyGhqoWhAr9ubUd4zh10xpUoNLlvpeewpzUig2ErGGzLBi4lRqY0gpUqfG6IY8kkJQR_nVXj3Ir47yK8BsmFGvzwSzybI-Yv7qnQvenQooj3lwFFWyjrzNK4hkJ9UG9x-C9__gbe_yFnT_kxZK-zBHnxVUqFKpQH05XsDxAFAAAJbfxR97a7Bs</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Ghosh, Justin, MBBS</creator><creator>Sepahpour, Ali, MBBS</creator><creator>Chan, Kim H., MBBS</creator><creator>Singarayar, Suresh, MBBS, PhD</creator><creator>McGuire, Mark A., MBBS, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation</title><author>Ghosh, Justin, MBBS ; Sepahpour, Ali, MBBS ; Chan, Kim H., MBBS ; Singarayar, Suresh, MBBS, PhD ; McGuire, Mark A., MBBS, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-5df5a312837bebc66bbae4639cb6dc3c63ce7308ab60dec918e360a5ba0805d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Ablation</topic><topic>Adult</topic><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiovascular</topic><topic>Cryoballoon</topic><topic>Cryosurgery - adverse effects</topic><topic>Cryosurgery - methods</topic><topic>Female</topic><topic>Heart Atria - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Paralysis - etiology</topic><topic>Paralysis - prevention &amp; control</topic><topic>Paralysis - surgery</topic><topic>Phrenic Nerve - injuries</topic><topic>Phrenic Nerve - surgery</topic><topic>Phrenic nerve palsy</topic><topic>Postoperative Complications - prevention &amp; control</topic><topic>Pulmonary Veins - surgery</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghosh, Justin, MBBS</creatorcontrib><creatorcontrib>Sepahpour, Ali, MBBS</creatorcontrib><creatorcontrib>Chan, Kim H., MBBS</creatorcontrib><creatorcontrib>Singarayar, Suresh, MBBS, PhD</creatorcontrib><creatorcontrib>McGuire, Mark A., MBBS, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghosh, Justin, MBBS</au><au>Sepahpour, Ali, MBBS</au><au>Chan, Kim H., MBBS</au><au>Singarayar, Suresh, MBBS, PhD</au><au>McGuire, Mark A., MBBS, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>10</volume><issue>5</issue><spage>646</spage><epage>652</epage><pages>646-652</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Persistent phrenic nerve palsy is the most frequent complication of cryoballoon ablation for atrial fibrillation and can be disabling. Objectives To describe a technique—immediate balloon deflation (IBD)—for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary vein. Methods Cryoballoon procedures for atrial fibrillation were analyzed retrospectively (n = 130). IBD was performed in patients developing phrenic nerve dysfunction (n = 22). In vitro simulations were performed by using phantoms. Results No adverse events occurred, and all patients recovered normal phrenic nerve function before leaving the procedure room. No patient developed persistent phrenic nerve palsy. The mean cryoablation time to onset of phrenic nerve dysfunction was 144±64 seconds. Transient phrenic nerve dysfunction was seen more frequently with the 23-mm balloon than with the 28-mm balloon (11 of 39 cases vs 11 of 81 cases; P = .036). Balloon rewarming was faster following IBD. The time to return to 0 and 20° C was shorter in the IBD group (6.7 vs 8.9 seconds; P = .007 and 16.7 vs 37.6 seconds; P &lt;.0001). In vitro simulations confirmed that IBD caused more rapid tissue warming (time to 0°C, 14.0±3.4 seconds vs 46.0±8.1; P = .0001) and is unlikely to damage the atrium or pulmonary vein. Conclusions IBD results in more rapid tissue rewarming, causes no adverse events, and appears to prevent persistent phrenic nerve palsy. Simulations suggest that IBD is unlikely to damage the atrium or pulmonary vein.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23333737</pmid><doi>10.1016/j.hrthm.2013.01.011</doi><tpages>7</tpages></addata></record>
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source MEDLINE; Elsevier ScienceDirect Journals Complete
subjects Ablation
Adult
Aged
Atrial fibrillation
Atrial Fibrillation - surgery
Cardiovascular
Cryoballoon
Cryosurgery - adverse effects
Cryosurgery - methods
Female
Heart Atria - surgery
Humans
Male
Middle Aged
Paralysis - etiology
Paralysis - prevention & control
Paralysis - surgery
Phrenic Nerve - injuries
Phrenic Nerve - surgery
Phrenic nerve palsy
Postoperative Complications - prevention & control
Pulmonary Veins - surgery
Retrospective Studies
Treatment Outcome
title Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation
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