{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:06:03Z","timestamp":1784203563982,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Phrenic nerve injury (PNI) remains a clinically relevant complication of atrial fibrillation (AF) ablation, and contemporary device\u2010specific risk and recovery data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We analyzed a large multicenter database to compare PNI incidence across device platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational study consisted of 19,764 consecutive AF ablations at 20 centers between January 2022 and November 2025. PNI was defined as elevation of the right hemidiaphragm on the next\u2010day post\u2010procedural chest X\u2010ray.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PNI occurred in 202 patients; 24 were attributed to radiofrequency ablation (RFA) and 178 to non\u2010RFA during right superior or inferior pulmonary vein (RSPV\/RIPV) isolation (Arctic Front Advance [AFA] 43, POLARx 62, POLARx FIT 69, laser balloon 1, hot balloon 2, and pulsed field ablation (1). Cryoballoon\u2010related PNI incidence differed by platform (AFA 1.7%\u00a0vs. POLARx 4.1%\u00a0versus POLARx FIT 4.2%; overall\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), with Holm\u2010adjusted differences for AFA versus POLARx\/POLARx FIT (both\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). In the cryoballoon cohort, younger age (odds ratio [OR] 0.98), female sex (OR 1.94), lower body mass index (BMI) (OR 0.94), deep sedation\/general anesthesia (OR 2.0, vs. light sedation), and POLARx\/POLARx FIT use (OR 2.43\/2.72, vs. AFA) were independently associated with PNI. Overall recovery was observed in 187\/202 (92.6%). Recovery curves differed by presumed injury site (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006), with faster recovery for RSPV\u2010 (vs. RIPV\u2010related PNI); RFA\u2010related PNI during superior vena cava\/right atrial ablation tended to recover more slowly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The cryoballoon platform was associated with PNI risk, while most PNIs recovered; recovery time course varied by presumed injury site and BMI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70360","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:23:57Z","timestamp":1784201037000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phrenic Nerve Injury After Catheter Ablation for Atrial Fibrillation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3413-2629","authenticated-orcid":false,"given":"Shinichi","family":"Tachibana","sequence":"first","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Saitama Hospital  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-0934","authenticated-orcid":false,"given":"Shinsuke","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Nitta","sequence":"additional","affiliation":[{"name":"Department of Cardiology Sakakibara Heart Institute  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Cardiology NHO Disaster Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-2999","authenticated-orcid":false,"given":"Yasuteru","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Yokohama City Bay Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ome Medical Center  Ome Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Musashino Hospital  Musashino Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Hachiya","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Saitama Hospital  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Iwai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hiratsuka Kyosai Hospital  Hiratsuka Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihide","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shin\u2010yurigaoka General Hospital  Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Sakakibara Heart Institute  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9343-4614","authenticated-orcid":false,"given":"Hirofumi","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Yokohama City Bay Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-4422","authenticated-orcid":false,"given":"Tomoki","family":"Horie","sequence":"additional","affiliation":[{"name":"Department of Cardiology Japanese Red Cross Musashino Hospital  Musashino Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoyuki","family":"Miwa","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Sasano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.ahj.2014.09.011","article-title":"Prevalence and Clinical Outcome of Phrenic Nerve Injury During Superior Vena Cava Isolation and Circumferential Pulmonary Vein Antrum Isolation Using Radiofrequency Energy","volume":"168","author":"Miyazaki S.","year":"2014","journal-title":"American Heart Journal"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1093\/europace\/euu320","article-title":"Incidence and Characteristics of Phrenic Nerve Palsy Following Pulmonary Vein Isolation With the Second\u2010Generation as Compared With the First\u2010Generation Cryoballoon in 360 Consecutive Patients","volume":"17","author":"Furnkranz A.","year":"2015","journal-title":"Europace"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation","volume":"374","author":"Kuck K.\u2010H.","year":"2016","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1093\/europace\/euz155","article-title":"Outcomes of Cryoballoon or Radiofrequency Ablation in Symptomatic Paroxysmal or Persistent Atrial Fibrillation","volume":"21","author":"Hoffmann E.","year":"2019","journal-title":"EP Europace"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1093\/europace\/eux337","article-title":"Phrenic Nerve Injury During Right Inferior Pulmonary Vein Ablation With the Second\u2010Generation Cryoballoon: Clinical, Procedural, and Anatomical Characteristics","volume":"20","author":"Abugattas J.\u2010P.","year":"2018","journal-title":"EP Europace"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.008249","article-title":"Characteristics of Phrenic Nerve Injury During Pulmonary Vein Isolation Using a 28\u2010Mm Second\u2010Generation Cryoballoon and Short Freeze Strategy","volume":"7","author":"Miyazaki S.","year":"2018","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_13_8_1","article-title":"Phrenic Nerve Injury During Cryoballoon\u2010Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry","volume":"15","author":"Heeger C.\u2010H.","year":"2022","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_13_9_1","article-title":"Preclinical Evaluation of Pulsed Field Ablation","volume":"12","author":"Koruth J.","year":"2019","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1038\/s41591-024-03114-3","article-title":"Safety of Pulsed Field Ablation in More Than 17,000 Patients With Atrial Fibrillation in the MANIFEST\u201017K Study","volume":"30","author":"Ekanem E.","year":"2024","journal-title":"Nature Medicine"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar J. A.","year":"2024","journal-title":"Circulation"},{"key":"e_1_2_13_12_1","first-page":"605","article-title":"Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation","volume":"7","author":"Mond\u00e9sert B.","year":"2014","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae092","article-title":"Incidence of Phrenic Nerve Injury During Pulmonary Vein Isolation Using Different Cryoballoons: Data From a Large Prospective Ablation Registry","volume":"26","author":"Tachibana S.","year":"2024","journal-title":"Europace"},{"key":"e_1_2_13_14_1","first-page":"1367","article-title":"PolarX vs Arctic Front for Cryoballoon Ablation of Paroxysmal AF","volume":"10","author":"Reichlin T.","year":"2024","journal-title":"JACC: Clinical Electrophysiology"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15182"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac100"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac094"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrcr.2025.05.015"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.08.010"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv362"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.746820"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540\u20108167.2009.01495.x"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70360","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70360","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70360","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:23:59Z","timestamp":1784201039000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":21,"alternative-id":["10.1111\/pace.70360"],"URL":"https:\/\/doi.org\/10.1111\/pace.70360","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"2026-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70360"}}