Contemporary Analysis of Phrenic Nerve Injuries Following Cryoballoon-based Pulmonary Vein Isolation: A Single-centre Experience with the Systematic Use of Compound Motor Action Potential Monitoring

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Jun 26

PMID 32584880

Citations 3

Authors

Omar Anwar

Melanie A Gunawardene

Jannis Dickow

Katharina Scherschel

Christiane Jungen

Paula Munkler

Christian Eickholt

Stephan Willems

Nele Gessler

Christian Meyer

Affiliations

Soon will be listed here.

Abstract

Background: Phrenic nerve injury (PNI) remains one of the most frequent complications during cryoballoon-based pulmonary vein isolation (CB-PVI). Since its introduction in 2013, the use of compound motor action potential (CMAP) for the prevention of PNI during CB-PVI is increasing; however, systematic outcome data are sparse.

Methods: The CMAP technique was applied in conjunction with abdominal palpation during pacing manoeuvres (10 mV, 2 ms) from the superior vena cava for 388 consecutive patients undergoing CB-PVI between January 2015 and May 2017 at our tertiary arrhythmia centre. Cryoablation was immediately terminated when CMAP amplitude was reduced by 30%.

Results: Reductions in CMAP amplitude were observed in 16 (4%) of 388 patients during isolation of the right veins. Of these, 11 (69%) patients did not manifest a reduction in diaphragmatic excursions. The drop in CMAP amplitude was observed in 10 (63%) patients during ablation of the right superior pulmonary veins (PVs) and in 7 (44%) patients during ablation of the right inferior PVs. Postprocedural persistent PNI was observed in three of four patients for a duration of 6 months, with one of these patients remaining symptomatic at the 24-month follow-up. One of the four patients was lost to long-term follow-up.

Conclusions: All PNIs occurred during right-sided CB-PVI and were preceded by a reduction in CMAP amplitude. Thus, the standardized use of CMAP surveillance during CB-PVI is easily applicable, reliable and compared with other studies, results in a lower number of PNIs.

Citing Articles

Computer Simulation of Catheter Cryoablation for Pulmonary Vein Isolation.

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PMID: 39120212 PMC: 11312416. DOI: 10.3390/healthcare12151508.

Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies.

He C, Zhang W, Yin L, Sun M, Zhao Z, Ye G Front Cardiovasc Med. 2023; 10:1195492.

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A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation.

Anwar O, Chung D, Gunawardene M, Jungen C, Hartmann J, Meyer C Medicina (Kaunas). 2022; 58(12).

PMID: 36556902 PMC: 9781762. DOI: 10.3390/medicina58121700.

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