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Mol D, Renskers L, Balt JC, Bhagwandien RE, Blaauw Y, van Driel VJHM, Driessen AHG, Elvan A, Folkeringa R, Hassink R, Hooft van Huysduynen B, Luermans JGLM, Stevenhagen JY, van der Voort PH, Westra SW, de Groot JR, de Jong JSSG. Persistent Phrenic Nerve Palsy after Atrial Fibrillation Ablation: Follow-up Data from the Netherlands Heart Registration. J Cardiovasc Electrophysiol 2022; 33:559-564. [PMID: 35040534 PMCID: PMC9303579 DOI: 10.1111/jce.15368] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/07/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
Background Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP‐related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study. Methods In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow‐up data were collected for patients who developed persistent PNP. Results Overall, the mean age was 62 ± 10 years, and 67.7% were male. Fifty‐four (0.7%) patients developed persistent PNP and follow‐up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional‐RF, phased‐RF, cryoballoon, and thoracoscopic ablation respectively. Seventy‐one percent of the patients fully recovered, and 86% were free of PNP‐related symptoms after a median follow‐up of 203 (113–351) and 184 (82–359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery. Conclusion After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
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Affiliation(s)
- Daniel Mol
- OLVG, Department of Cardiology, Amsterdam, the Netherlands.,Amsterdam University Medical Centres/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, the Netherlands
| | | | - Jippe C Balt
- St. Antonius, Department of Cardiology, Nieuwegein, the Netherlands
| | - Rohit E Bhagwandien
- Erasmus Medical Centre, Department of Cardiology, Rotterdam, the Netherlands
| | - Yuri Blaauw
- University Medical Centre Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Antoine H G Driessen
- Amsterdam University Medical Centres/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, the Netherlands
| | - Arif Elvan
- Isala, Department of Cardiology, Zwolle, the Netherlands
| | - Richard Folkeringa
- Medical Centre Leeuwarden, Department of Cardiology, Leeuwarden, the Netherlands
| | - Rutger Hassink
- University Medical Centre Utrecht, Department of Cardiology, Utrecht, the Netherlands
| | | | - Justin G L M Luermans
- Maastricht University Medical Centre, Department of Cardiology, Maastricht, the Netherlands
| | | | - Pepijn H van der Voort
- Catharina Hospital, Department of Cardiology and Cardiac Surgery, Eindhoven, the Netherlands
| | - Sjoerd W Westra
- Radboud University Medical Centre, Department of Cardiology, Nijmegen, the Netherlands
| | - Joris R de Groot
- Amsterdam University Medical Centres/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, the Netherlands
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- OLVG, Department of Cardiology, Amsterdam, the Netherlands
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Hernández-Hernández MA, Sánchez-Moreno L, Orizaola P, Iturbe D, Álvaréz C, Fernández-Rozas S, González-Novoa V, Llorca J, Hernández JL, Fernández-Torre JL, Parra JA. A prospective evaluation of phrenic nerve injury after lung transplantation: Incidence, risk factors, and analysis of the surgical procedure. J Heart Lung Transplant 2021; 41:50-60. [PMID: 34756781 DOI: 10.1016/j.healun.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Phrenic nerve injury (PNI) is a complication of lung transplantation related to the surgical procedure and associated with increased morbidity. However, the incidence and risk factors, specifically regarding surgical techniques, have not been adequately studied. METHODS We conducted a prospective single-center study over 4-years, in recipients of lung transplantation with a normal pretransplant phrenic nerve conduction study (PNCS). Diaphragm ultrasound and PNCS were performed in the first 21 postoperative days and PNI was defined when both tests were abnormal. Patients were followed up until hospital discharge. The association between transplant characteristics and PNI was analyzed by using logistic regression models. RESULTS Two hundred eleven lung grafts implanted in 127 patients were included in the study. After lung transplantation, PNI was diagnosed in 43.3% of the subjects and 29% of the operated hemithorax. Regression logistic model showed that the variables related to PNI were female gender (p = 0.02), bilateral lung transplantation (BLT) (p = 0.001), right lung graft (p = 0.003), clamshell incision (p = 0.01), mediastinal adhesions (p = 0.002), longer operative time (p = 0.003), intraoperative extracorporeal support (p = 0.02), and blood transfusion (p = 0.003). Conversely, age >61 years (p = 0.008) and higher thoracic diameter (p = 0.04) were protective factors. The use of electrocautery, cardiac mechanical retractors, and diaphragmatic traction was not associated with PNI. Morbidity was increased without any difference in mortality. CONCLUSIONS PNI is a frequent complication after lung transplantation, associated with higher morbidity. Mainly risk factors were age, BLT, female gender, and variables related to surgical difficulties. Lung graft in the right hemithorax and mediastinal adhesiolysis were the most relevant technical variables.
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Affiliation(s)
- Miguel A Hernández-Hernández
- Department of Intensive Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Laura Sánchez-Moreno
- Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Thoracic Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Pedro Orizaola
- Department of Clinical Neurophysiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - David Iturbe
- Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Álvaréz
- Department of Thoracic Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonia Fernández-Rozas
- Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Respiratory Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Vanesa González-Novoa
- Department of Rehabilitation, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Llorca
- Biomedical Research Institute (IDIVAL), Santander, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain; Faculty of Medicine, University of Cantabria, Santander, Spain
| | - José L Hernández
- Biomedical Research Institute (IDIVAL), Santander, Spain; Faculty of Medicine, University of Cantabria, Santander, Spain; Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José L Fernández-Torre
- Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Clinical Neurophysiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Faculty of Medicine, University of Cantabria, Santander, Spain
| | - José A Parra
- Biomedical Research Institute (IDIVAL), Santander, Spain; Faculty of Medicine, University of Cantabria, Santander, Spain; Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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