Conclusion In patients with paroxysmal atrial fibrillation  , cryoballoon and radiofrequency ablation produce similar results in terms of freedom from recurrent atrial fibrillation or atrial tachyarrhythmias but with a different safety profile , being cryoballoon ablation less associated with cardiac complications but more likely to cause phrenic nerve palsy
Aims To perform an up date d meta- analysis to assess efficacy , safety and technical performance of pulmonary vein isolation using cryoballoon or radiofrequency catheter ablation in patients with paroxysmal or persistent atrial fibrillation .
Histopathology of cryoballoon ablation-induced phrenic nerve injury.
INTRODUCTION Hemi-diaphragmatic paralysis is the most common complication associated with cryoballoon ablation for atrial fibrillation , yet the histopathology of phrenic nerve injury has not been well described . METHODS AND RESULTS A pre clinical r and omized study was conducted to characterize the histopathology of phrenic nerve injury induced by cryoballoon ablation and assess the potential for electromyographic ( EMG ) monitoring to limit phrenic nerve damage . Thirty-two dogs underwent cryoballoon ablation of the right superior pulmonary vein with the objective of inducing phrenic nerve injury . Animals were r and omized 1:1 to st and ard monitoring ( i.e. , interruption of ablation upon reduction in diaphragmatic motion ) versus EMG guidance ( i.e. , cessation of ablation upon a 30 % reduction in the diaphragmatic compound motor action potential [ CMAP ] amplitude ) . The acute procedural endpoint was achieved in all dogs . Phrenic nerve injury was characterized by Wallerian degeneration , with subperineural injury to large myelinated axons and evidence of axonal regeneration . The degree of phrenic nerve injury paralleled the reduction in CMAP amplitude ( P = 0.007 ) . Animals r and omized to EMG guidance had a lower incidence of acute hemi-diaphragmatic paralysis ( 50 % vs 100 % ; P = 0.001 ) , persistent paralysis at 30 days ( 21 % vs 75 % ; multivariate odds ratio 0.12 , 95 % confidence interval [ 0.02 , 0.69 ] , P = 0.017 ) , and a lesser severity of histologic injury ( P = 0.001 ) . Mature pulmonary vein ablation lesion characteristics , including circumferentiality and transmurality , were similar in both groups . CONCLUSION Phrenic nerve injury induced by cryoballoon ablation is axonal in nature and characterized by Wallerian degeneration , with potential for recovery . An EMG-guided approach is superior to st and ard monitoring in limiting phrenic nerve damage
Conclusion In patients with paroxysmal atrial fibrillation  , cryoballoon and radiofrequency ablation produce similar results in terms of freedom from recurrent atrial fibrillation or atrial tachyarrhythmias but with a different safety profile , being cryoballoon ablation less associated with cardiac complications but more likely to cause phrenic nerve palsy
Aims To perform an up date d meta- analysis to assess efficacy , safety and technical performance of pulmonary vein isolation using cryoballoon or radiofrequency catheter ablation in patients with paroxysmal or persistent atrial fibrillation .