{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:38:29Z","timestamp":1791992309923,"version":"4.4.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2022,1]]},"abstract":"\n Background:<\/jats:title>\n Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n A total of 17\u2009356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7\u00b150.4 seconds, and the mean temperature at the time of PNI was \u221249\u00b18\u00b0C. At the end of the procedure, PNI recovered in 394\/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682\/703, with 28 patients lost to follow-up). A total of 16\/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI.<\/jats:p>\n <\/jats:sec>\n \n Registration:<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n ; Unique identifier: NCT03645577.\n <\/jats:p>\n <\/jats:sec>\n \n Graphic Abstract:<\/jats:title>\n A graphic abstract is available for this article.<\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/circep.121.010516","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T10:00:27Z","timestamp":1640685627000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":108,"title":["Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry"],"prefix":"10.1161","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct03645577","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9014-8097","authenticated-orcid":true,"given":"Christian-H.","family":"Heeger","sequence":"first","affiliation":[{"name":"University Heart Center L\u00fcbeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)."},{"name":"Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.)."},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Germany (C.-H.H., R.R.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0490-5862","authenticated-orcid":true,"given":"Christian","family":"Sohns","sequence":"additional","affiliation":[{"name":"Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., 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