Key result
CMAP monitoring during cryoballoon ablation cuts persistent phrenic nerve injury risk by ~53%.
Why the study?
The reported incidence of right phrenic nerve injury during cryoballoon ablation isolation of the right pulmonary veins varies widely depending on changes over time, cryoballoon ablation generation, and protective methods.
Does CMAP monitoring reduce the risk of persistent right phrenic nerve injury in patients undergoing cryoballoon ablation?
Meta-Analysis (n=10,341)
Does CMAP monitoring reduce the risk of persistent right phrenic nerve injury in patients undergoing cryoballoon ablation?
CMAP monitoring during cryoballoon ablation significantly reduces the risk of persistent right phrenic nerve injury and shortens the time to recovery.
CMAP monitoring should be considered standard in cryoballoon ablation to halve persistent PNI risk; confirms benefit in Level-1 meta-analysis.
Background: The right phrenic nerve is vulnerable to injury (rPNI) during cryoballoon ablation (CBA) isolation of the right pulmonary veins. The complication can be transient or persistent. The reported incidence of rPNI fluctuates from 4.73% to 24.7% depending on changes over time, CBA-generation, and selected protective methods. Methods: Through September 2019, a database search was performed on MEDLINE, EMBASE, and Cochrane Database. In the selected articles, the references were also extensively searched. The study provides a comprehensive meta-analysis of the overall prevalence of rPNI, assesses the transient to persistent PNI-ratio, the outcome of using compound motor action potentials (CMAP), and estimated average time to nerve recovery. Results: From 2008 to 2019, 10,341 records from 48 trials were included. Out of 783 eighty- PNI (7.7%), 589 (5.7%) were transient, and 194 (1.9%) were persistent. CMAP caused a significant reduction in the risk of persistent PNI from 2.3% to 1.1% (p = 0.05; odds ratio [OR] 2.13) in all CBA groups. The mean time to rPNI recovery extended beyond the hospital discharge was significantly shorter in CMAP group at three months on average versus non CMAP at six months (p = 0.012). CMAP (in contrast to non-CMAP procedures) detects PNI earlier from 4 to 16 sec (p < 0.05; I2 = 74.53%) and 3 to 9º (p < 0.05; I2 = 97.24%) earlier. Conclusions: rPNI extending beyond hospitalization is a relatively rare complication. CMAP use causes a significant decrease in the risk of prolonged injury and shortens the time to recovery
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Kuniewicz et al. (2023) conducted a meta-analysis in Right phrenic nerve injury during cryoballoon ablation (n=10,341). Compound motor action potentials (CMAP) monitoring vs. Non-CMAP procedures was evaluated on Persistent phrenic nerve injury (OR 2.13, p=0.05). Compound motor action potential (CMAP) monitoring during cryoballoon ablation significantly reduced the risk of persistent phrenic nerve injury from 2.3% to 1.1% (OR 2.13; p=0.05).
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