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Phrenic Nerve Injury After Catheter Ablation for Atrial Fibrillation
Shinichi Tachibana1, Shinsuke Miyazaki2, Junichi Nitta3
1Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan.
Pacing and Clinical Electrophysiology : PACE
|July 16, 2026
Summary
Phrenic nerve injury (PNI) is a risk during atrial fibrillation (AF) ablation. Cryoballoon devices showed varied PNI rates, but most injuries recovered, with recovery influenced by injury site and BMI.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Phrenic nerve injury (PNI) is a known complication of atrial fibrillation (AF) ablation.
- Limited data exists on device-specific PNI incidence and recovery patterns.
Purpose of the Study:
- To compare the incidence of PNI across different device platforms used in AF ablation.
- To identify factors associated with PNI and analyze recovery outcomes.
Main Methods:
- A prospective observational study involving 19,764 consecutive AF ablations across 20 centers.
- PNI was diagnosed via chest X-ray showing right hemidiaphragm elevation post-procedure.
- Data collected on device type, ablation site, patient demographics, and recovery.
Main Results:
- PNI occurred in 202 patients, with cryoballoon ablation showing differing incidence rates by platform (Arctic Front Advance, POLARx, POLARx FIT).
- Independent factors associated with PNI in the cryoballoon cohort included younger age, female sex, lower BMI, deep sedation, and specific device platforms.
- Overall recovery was 92.6%, with recovery time varying based on the presumed injury site and patient BMI.
Conclusions:
- The cryoballoon platform is associated with PNI risk in AF ablation.
- Most PNI cases demonstrate recovery, though the time course can be influenced by the injury location and patient's BMI.
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