{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T23:14:16Z","timestamp":1784243656600,"version":"3.55.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,4,3]]},"abstract":"\n Background<\/jats:title>\n \n The reported incidence of phrenic nerve injury (\n PNI<\/jats:styled-content>\n ) varies owing to different definitions, balloon generations, balloon size, freezing regimen, and protective maneuvers. We evaluated the incidence, predictors, and outcome of\n PNI<\/jats:styled-content>\n during cryoballoon pulmonary vein isolation in a large population.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Five hundred fifty atrial fibrillation patients underwent\n pulmonary vein isolation<\/jats:styled-content>\n using one 28\u2010mm second\u2010generation cryoballoon and single 3\u2010minute freeze strategy under diaphragmatic compound motor action potential (\n CMAP<\/jats:styled-content>\n ) monitoring. A total of 34 (6.2%) patients experienced\n PNI<\/jats:styled-content>\n during the right superior and inferior\n pulmonary vein<\/jats:styled-content>\n ablation in 30 and 4 patients, respectively. Applications were interrupted using double\u2010stop techniques after 136 [104\u2013158] second applications, and a\n pulmonary vein isolation<\/jats:styled-content>\n was already achieved in all but one case. The baseline\n CMAP<\/jats:styled-content>\n amplitude and timing of deflation (\n CMAP<\/jats:styled-content>\n def<\/jats:sub>\n ) were 0.75\u00b10.30 and 0.17\u00b10.17 mV, respectively. Persistent\n atrial fibrillation<\/jats:styled-content>\n , larger\n right superior pulmonary vein<\/jats:styled-content>\n ostia, and deeper balloon positions were associated with higher incidences of\n PNI<\/jats:styled-content>\n . The\n CMAP<\/jats:styled-content>\n def<\/jats:sub>\n predicted a\n PNI<\/jats:styled-content>\n recovery delay, and the best cutoff value for predicting\n PNI<\/jats:styled-content>\n recovery by the next day was 0.20 mV (sensitivity 57.1%, specificity 100%). Among 6 patients undergoing second procedures 8.5 (6.7\u201315.0) months later, the right superior pulmonary vein was durable in 3 with >120 second applications. Despite active balloon deflation, no significant\n pulmonary vein<\/jats:styled-content>\n stenosis was observed in 15\n right superior pulmonary vein<\/jats:styled-content>\n s evaluated 6 (5\u20139) months later. No patients had symptoms, and the\n PNI<\/jats:styled-content>\n recovered 1 day and 1 month postprocedure in 21 and 4 patients, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n PNI<\/jats:styled-content>\n resulting from cryoballoon ablation was reversible. The double\u2010stop technique is safe, and immediate active deflation following a\n CMAP<\/jats:styled-content>\n decrease appears to be essential for faster\n PNI<\/jats:styled-content>\n recovery.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.008249","type":"journal-article","created":{"date-parts":[[2018,3,24]],"date-time":"2018-03-24T09:40:12Z","timestamp":1521884412000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Characteristics of Phrenic Nerve Injury During Pulmonary Vein Isolation Using a 28\u2010mm Second\u2010Generation Cryoballoon and Short Freeze Strategy"],"prefix":"10.1161","volume":"7","author":[{"given":"Shinsuke","family":"Miyazaki","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Fukui University, Fukui, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takatsugu","family":"Kajiyama","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Hada","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Yamao","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Kusa","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyako","family":"Igarashi","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, 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":"Hiroshi","family":"Tada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Fukui University, Fukui, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenzo","family":"Hirao","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshito","family":"Iesaka","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.12.016"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.192419"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.11.064"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602014"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.02.050"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.01.002"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12358"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.03.021"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.01.047"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.06.019"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.01.011"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv362"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv346"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13078"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-16-1334"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12296"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.06.022"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12114"}],"container-title":["Journal 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