{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:11:36Z","timestamp":1792642296537,"version":"4.5.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulsed field ablation (PFA) is an emerging non-thermal ablation modality for atrial fibrillation (AF), characterized by its myocardial selectivity and reduced risk of collateral damage to extracardiac structures such as the oesophagus and phrenic nerve (PN). While transient phrenic nerve injury (PNI) has been reported, persistent diaphragmatic paralysis remains exceedingly rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report the case of a 49-year-old man with paroxysmal AF, refractory to medical therapy, who underwent pulmonary vein isolation using the FARAPULSE PFA system. The procedure was uneventful, and the patient was discharged the same day. However, he reported significant breathlessness on minimal exertion starting the day after the procedure. At his 6-week follow-up, physical examination revealed reduced air entry at the right lung base. A contrast-enhanced computed tomography chest confirmed an elevated right hemidiaphragm (9.0\u2005cm posteriorly, 7.5\u2005cm anteriorly), consistent with right PN palsy. The patient remained in sinus rhythm and asymptomatic from an arrhythmic standpoint, but continues to experience persistent dyspnoea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>To our knowledge, this represents one of the early cases of persistent PN palsy following PFA with the FARAPULSE system. Although PFA is designed to target cardiomyocytes while sparing adjacent tissues selectively, proximity to the right PN\u2014particularly near the right superior pulmonary vein\u2014may still pose a risk. This case highlights the importance of procedural vigilance, including meticulous catheter positioning and careful consideration of nerve proximity. It highlights that persistent PNI, while rare, remains a potential complication of PFA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag065","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:13:27Z","timestamp":1769516007000},"source":"Crossref","is-referenced-by-count":1,"title":["A case report of persistent phrenic nerve injury following pulsed field ablation using a pentaspline catheter"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6968-9952","authenticated-orcid":false,"given":"Thet","family":"Su Su","sequence":"first","affiliation":[{"name":"Department of Cardiology, Glenfield Hospital , Groby Road, Leicester LE3 9QP ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-7476","authenticated-orcid":false,"given":"Ibrahim","family":"Antoun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Glenfield Hospital , Groby Road, Leicester LE3 9QP ,","place":["UK"]},{"name":"Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Leicester LE3 9QP ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5162-3644","authenticated-orcid":false,"given":"Riyaz","family":"Somani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Leicester LE3 9QP ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"2026021608265656300_ytag065-B1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"Lippi","year":"2021","journal-title":"Int J 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catheter for the treatment of paroxysmal atrial fibrillation: results of the prospective, multicentre FARA-Freedom Study","volume":"26","author":"Metzner","year":"2024","journal-title":"Europace"},{"key":"2026021608265656300_ytag065-B11","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa2307291","article-title":"Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation","volume":"389","author":"Reddy","year":"2023","journal-title":"N Engl J Med"},{"key":"2026021608265656300_ytag065-B12","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.hrcr.2024.04.004","article-title":"First electromyographic monitoring of a progressive phrenic nerve palsy in a pulsed field ablation procedure","volume":"10","author":"Franceschi","year":"2024","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - Case 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