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Clinical Trial
. 2020 Jun 25;15(6):e0235132.
doi: 10.1371/journal.pone.0235132. eCollection 2020.

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

Omar Anwar  1 , Melanie A Gunawardene  1 , Jannis Dickow  2 , Katharina Scherschel  2   3   4 , Christiane Jungen  2   3 , Paula Münkler  2   3 , Christian Eickholt  1   3 , Stephan Willems  1   3 , Nele Gessler  1   3 , Christian Meyer  2   3   4   5
Affiliations
Clinical Trial

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

Omar Anwar et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Placement of electrodes for CMAP.
Fig 2
Fig 2. Phrenic nerve pacing.
A. Phrenic nerve pacing through coronary sinus (CS) catheter via superior vena cava during cryoablation. Lead I is modified (see CMAP and CMAP monitoring) and the “horizontal line” is used as a visual aid in order to assess any changes in CMAP amplitude (baseline CMAP amplitude). B. Reduction in CMAP amplitude with complete loss of capture (left to right) during cryoablation of the RSPV. CMAP = compound motor action potential, RSPV = right superior PV.
See this image and copyright information in PMC

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