Key result
Phrenic nerve capture during pulmonary vein orifice pacing was associated with a higher risk of transient phrenic nerve injury or ≥30% decrease in CMAP amplitude (54% vs 13%; P<0.001).
Why the study?
Does phrenic nerve capture with pulmonary vein orifice pacing predict phrenic nerve injury during cryoballoon ablation in patients with atrial fibrillation?
Cohort (n=70)
Does phrenic nerve capture with pulmonary vein orifice pacing predict phrenic nerve injury during cryoballoon ablation in patients with atrial fibrillation?
Phrenic nerve capture during pulmonary vein orifice pacing is a feasible technique to predict transient phrenic nerve injury and CMAP amplitude reductions before cryoballoon ablation.
Answers are grounded in this paper and cite their sources.
May identify higher-risk patients before cryoballoon ablation; leaves open need for prospective validation before practice change.
INTRODUCTION: Phrenic nerve (PN) injury is a well-known complication of cryoballoon ablation (CBA) for pulmonary vein (PV) isolation in patients with atrial fibrillation. However, it is still insufficient to practically predict phrenic nerve injury (PNI) before freezing. We hypothesized that phrenic nerve capture (PNC) with phrenic nerve orifice pacing (PVOP) might be a surrogate sign of the close proximity of the PN, and that might predict PNI and changes in the compound motor action potential (CMAP) amplitude. METHODS: Seventy patients (60 ± 12 years, male 80%, paroxysmal 56%) underwent PVOP with a 20-electrode ring catheter before the CBA. The clinical outcome was the occurrence of transient and persistent PNI. In addition, the PV position and pacing threshold during PNC with PVOP, and changes in the CMAP amplitude were recorded. We compared these measurements between patients with and without PNC (PNC/non-PNC group) with PVOP. RESULTS: PNC with PVOP occurred in 39 (56%) patients and was localized only to the right superior PV. Transient PNI occurred in seven (10%) patients and permanent in none. The CMAP amplitude decreased significantly more in the PNC group (PNC 33% vs non-PNC 16%, P = .027). PNC group had a higher risk of the composite outcome of transient PNI or ≥30% decrease in the CMAP amplitude (PNC 54% vs non-PNC 13%; P < .001). CONCLUSIONS: This PVOP technique could be feasible and contribute to predicting transient PNI and CMAP amplitude reductions before cryoapplications. Further studies are necessary to elucidate the additional efficacy of PVOP over CMAP monitoring alone.
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Sano et al. (2019) conducted a cohort in Atrial fibrillation (n=70). Phrenic nerve capture with pulmonary vein orifice pacing vs. No phrenic nerve capture was evaluated on Composite outcome of transient phrenic nerve injury or ≥30% decrease in the CMAP amplitude (p=<.001). Phrenic nerve capture during pulmonary vein orifice pacing was associated with a higher risk of transient phrenic nerve injury or ≥30% decrease in CMAP amplitude (54% vs 13%; P<0.001).
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