Document Detail

Recordings of Diaphragmatic Electromyograms During Cryoballoon Ablation for Atrial Fibrillation Accurately Predict Phrenic Nerve Injury.
MedLine Citation:
PMID:  24252287     Owner:  NLM     Status:  Publisher    
BACKGROUND: Cryoballoon ablation has been associated with a significant incidence of phrenic nerve injury (PNI).
OBJECTIVE: We have evaluated the recordings of diaphragmatic compound motor action potentials (CMAP) on a modified lead I during cryoballoon ablation for predicting PNI.
METHODS: Cryoballoon ablation was performed in 109 patients with atrial fibrillation (AF). During ablation of the right-sided pulmonary veins, phrenic nerve was paced from the superior vena cava. The right and left arm electrodes from a 12 lead ECG were positioned 5 cm above the xiphoid process and 16 cm along the right costal margin. The amplitude of CMAP was recorded on a lead I during the ablation.
RESULTS: Cryoballoon was applied 424 times in 211 right-sided veins. PNI occurred in 7 (6.4%) patients. The average CMAP amplitude did not significantly change in patients without PNI from the initial average CMAP amplitude of 0.34 ± 0.18 mV to 0.32 ± 0.17 mV (p =0.58). In patients who developed PNI, there was a significant decrease in the initial average CMAP amplitude during the ablation from 0.33 ± 0.14 mV to 0.09 ± 0.05 mV (p <0.001). The maximal percent change in the average CMAP amplitude in patients with PNI was higher (70 ± 10%) than in patients without PNI (7.6 ± 7%) (p <0.001). In any patient without PNI, the CMAP amplitude did not decrease more than 35%.
CONCLUSION: Recording of CMAP amplitude on a modified lead I is reliable, and could be early and sensitive method in predicting PNI in patients undergoing cryoballoon ablation for AF.
Mayur Lakhani; Faisul Saiful; Valay Parikh; Nikhil Goyal; Soad Bekheit; Marcin Kowalski
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-16
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Published by Heart Rhythm Society on behalf of Heart Rhythm Society.
Electrophysiology Department, Staten Island University Hospital Staten Island, New York.
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