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

Phrenic nerve palsy (PNP) is a recognized complication of cryoballoon ablation (CBA) for atrial fibrillation (AF), particularly during the ablation of the right superior pulmonary vein (RSPV). We report the case of an 80-year-old female with a history of hypertension, who was admitted for CBA of paroxysmal AF. Despite optimal medical treatment with amiodarone, the patient experienced recurrent episodes of AF, prompting the decision to proceed with CBA. During the procedure, while isolating the RSPV, diaphragmatic movement was significantly weakened after 92 seconds of cryoablation at a temperature of –52°C. Immediate cessation of the procedure and intravenous methylprednisolone were administered, resulting in partial recovery of diaphragmatic movement. However, when the procedure resumed, diaphragmatic movement once again diminished, and despite further steroid treatment, the movement did not recover by discharge. The patient remained asymptomatic with stable oxygen saturation, and no respiratory distress was noted. At a six-month follow-up, the patient reported no symptoms of chest tightness or shortness of breath, and her general condition remained stable, although diaphragmatic movement had not fully recovered, indicating partial functional compensation. This case underscores the importance of continuous phrenic nerve monitoring during CBA, early detection of complications, and appropriate management to prevent irreversible injury, highlighting the need for careful procedural planning and postoperative follow-up in elderly patients with comorbidities.