From:  Prolonged phrenic nerve palsy during cryoballoon ablation of paroxysmal atrial fibrillation in an octogenarian female: a case report

 Timeline of clinical events.

Date/TimeEventDetails/FindingsManagement/Outcome
Baseline (pre-procedure)Admission80-year-old female, history of hypertension, recurrent paroxysmal AF despite amiodarone. LVEF 62%, LA 42 mm, no thrombus on TEEPlanned for CBA
Day 0—procedureCBA initiated28-mm fourth-generation cryoballoon, transseptal puncture, PV angiography performedStart of PVI
Day 0—during RSPV ablation (92 s, –52°C)First PNP episodeDiaphragmatic movement weakened, detected by phrenic nerve pacingCBA stopped, IV methylprednisolone 40 mg; partial recovery observed
Day 0—second RSPV ablation (112 s, –53°C)Recurrent PNPPersistent reduction of diaphragmatic movementCBA stopped, methylprednisolone repeated; no recovery
Day 0—completionRemaining veins ablatedLeft PVs isolated by CBA; right PVs completed by RFASuccessful PVI achieved
Post-procedure (hospital stay)Persistent right PNPNo dyspnea, SpO2 stable; treated with IV methylprednisolone for 3 daysNo diaphragmatic recovery at discharge
6-month follow-upTelephone consultationPatient asymptomatic, no chest tightness or dyspnea; declined chest X-rayStable condition, functional compensation suspected

AF: atrial fibrillation; CBA: cryoballoon ablation; IV: intravenous; LA: left atrium; LVEF: left ventricular ejection fraction; PNP: phrenic nerve palsy; PV: pulmonary vein; PVI: pulmonary vein isolation; RFA: radiofrequency ablation; RSPV: right superior pulmonary vein; TEE: transesophageal echocardiography.