The Lead Episode 120: A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation LIVE at HRX-The Lead Episode 120 (IH): A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation LIVE at HRX (Bonus Video)

The Lead Episode 120 (IH): A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation LIVE at HRX (Bonus Video)

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Video Summary

A 2025 study from Marseille reveals a surprisingly high incidence (40%) of phrenic nerve injury during pulse field ablation (PFA) for atrial fibrillation, primarily affecting the right superior pulmonary vein. Using sensitive CMAP monitoring, many injuries were clinically silent and often reversible, with only one patient showing persistent injury at 3 months. Although PFA was thought safer than thermal ablation, these findings prompt caution. Experts urge larger trials with longer follow-up and patient symptom assessments to determine clinical significance. Currently, no procedural changes are recommended, but operators should remain vigilant, especially when delivering multiple lesions near the phrenic nerve.

Keywords

phrenic nerve injury

pulse field ablation

atrial fibrillation

CMAP monitoring

right superior pulmonary vein