Key result
Electromyography-guided phrenic nerve monitoring using a hepatic vein approach was feasible in 88% of patients and resulted in no phrenic nerve palsy during cryoballoon ablation.
Why the study?
Does electromyography-guided phrenic nerve monitoring using a hepatic vein approach prevent right phrenic nerve palsy in patients undergoing cryoballoon ablation for atrial fibrillation?
Observational (n=57)
Does electromyography-guided phrenic nerve monitoring using a hepatic vein approach prevent right phrenic nerve palsy in patients undergoing cryoballoon ablation for atrial fibrillation?
Hepatic vein electromyography-guided phrenic monitoring appears feasible; leaves open clinical benefit for PNP prevention pending larger trials.
BACKGROUND: Right phrenic nerve palsy (PNP) is the most frequent complication of cryoballoon ablation. Diaphragmatic electromyography can predict PNP with a comfortable safety margin. Our goal was to evaluate the feasibility, efficacy, and safety of electromyography-guided PN monitoring using a novel hepatic vein approach for prevention of PNP. METHODS AND RESULTS: This study includes 57 patients (47 males) indicated for cryoballoon ablation for treatment of atrial fibrillation. During right superior pulmonary vein ablation, the PN was paced at 60 beats per minute and diaphragmatic compound motor action potential (CMAP) amplitude was recorded via a quadripolar catheter positioned in a subdiaphragmatic hepatic vein. If a 30% drop in CMAP amplitude was observed, ablation was discontinued with forced deflation. Reliable recording of CMAP before ablation was feasible in 50 of 57 patients (88%). In 7 patients (12%), stable PN pacing could not be achieved. In 44 of 50 patients, CMAP amplitude remained constant during cryoapplication. The mean value of CMAP amplitude was 639.7±240.5 µV; mean variation was 13±4.3%. In 6 of 50 patients (12%) including 5 treated with a 23-mm cryoballoon and 1 with a 28-mm cryoballoon, the 30% reduction cutoff was reached and cryoablation was discontinued. Recovery of CMAP amplitude after discontinuing cryoablation took <60 seconds in all cases. No PNP or complication related to PN monitoring occurred. CONCLUSIONS: Recording of diaphragmatic CMAP using a catheter positioned in a subdiaphragmatic hepatic vein seems feasible during cryoballoon ablation. Electromyography-guided PN monitoring seems safe and potentially helpful for prevention of PNP.
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Franceschi et al. (2013) conducted an observational in Atrial fibrillation (n=57). Electromyography-guided phrenic nerve monitoring using a hepatic vein approach was evaluated on Reliable recording of compound motor action potential (CMAP) before ablation. Electromyography-guided phrenic nerve monitoring using a hepatic vein approach was feasible in 88% of patients and resulted in no phrenic nerve palsy during cryoballoon ablation.
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