Electromyographic monitoring for prevention of phrenic nerve palsy in second-generation cryoballoon procedures

Circulation. Arrhythmia and Electrophysiology
Frédéric FranceschiJean-Claude Deharo

Abstract

Electromyography-guided phrenic nerve (PN) monitoring using a catheter positioned in a hepatic vein can aid in preventing phrenic nerve palsy (PNP) during cryoballoon ablation for atrial fibrillation. We wanted to evaluate the feasibility and efficacy of PN monitoring during procedures using second-generation cryoballoons. This study included 140 patients (43 women) in whom pulmonary vein isolation was performed using a second-generation cryoballoon. Electromyography-guided PN monitoring was performed by pacing the right PN at 60 per minute and recording diaphragmatic compound motor action potential (CMAP) via a quadripolar catheter positioned in a hepatic vein. If a 30% decrease in CMAP amplitude was observed, cryoapplication was discontinued with forced deflation to avoid a PNP. Monitoring was unfeasible in 8 of 140 patients (5.7%), PNP occurred in 1. Stable CMAP amplitudes were achieved before ablation in 132 of 140 patients (94.3%). In 18 of 132 patients (13.6%), a 30% decrease in CMAP amplitude occurred and cryoablation was discontinued. Each time, recovery of CMAP amplitude took <60 s. In 9 of 18 cases, a second cryoapplication in the same pulmonary vein was safely performed. We observed no PNP or complication related to ...Continue Reading

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Citations

Nov 11, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Jo Jo Hai, Hung-Fat Tse
Mar 26, 2016·Journal of Vascular and Interventional Radiology : JVIR·Aoife KilcoyneRonald S Arellano
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Apr 18, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Christian-H HeegerAndreas Metzner
Jun 1, 2016·BioMed Research International·Michaël PeyrolFrederic Franceschi
Jun 25, 2016·Journal of Cardiovascular Medicine·Giacomo MugnaiGian-Battista Chierchia
Jul 23, 2016·Journal of the American Heart Association·Emily N GuhlSandeep K Jain
Jun 3, 2017·AJNR. American Journal of Neuroradiology·J J Gemmete
Jul 25, 2020·JACC. Clinical Electrophysiology·Julia VoglerChristian-Hendrik Heeger
Aug 1, 2016·JACC. Clinical Electrophysiology·Tristram D Bahnson
Mar 25, 2021·Journal of Cardiovascular Electrophysiology·Christian-Hendrik HeegerRoland Richard Tilz

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