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-A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation LIVE at HRX Bonus Video

A Discussion of High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation LIVE at HRX Bonus Video

Back to course

Video Transcription

Video Summary

This discussion analyzes a 2025 Heart Rhythm Journal study revealing a high incidence (40%) of phrenic nerve injury during pulse field ablation (PFA) for atrial fibrillation (AFib). The prospective study of 64 patients used sensitive CMAP monitoring and fluoroscopy to detect nerve damage, mostly occurring near the right superior pulmonary vein. Although many injuries resolved by procedure end or three months later, some persisted subclinically without reported symptoms. Experts express surprise but caution, emphasizing the study’s small size, lack of symptom assessment, and short follow-up. They call for larger, multicenter trials to clarify PFA’s safety and clinical implications before altering practice.

Keywords

phrenic nerve injury

pulse field ablation

atrial fibrillation

CMAP monitoring

pulmonary vein