Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach.
atrial fibrillation
compound motor action potential
cryoballoon ablation
phrenic nerve palsy
pulmonary vein isolation
Journal
Frontiers in cardiovascular medicine
ISSN: 2297-055X
Titre abrégé: Front Cardiovasc Med
Pays: Switzerland
ID NLM: 101653388
Informations de publication
Date de publication:
2022
2022
Historique:
received:
12
11
2021
accepted:
17
01
2022
entrez:
25
2
2022
pubmed:
26
2
2022
medline:
26
2
2022
Statut:
epublish
Résumé
Compound motor action potential (CMAP) monitoring is a common method used to prevent right phrenic nerve palsy during cryoballoon ablation for atrial fibrillation. We compared recordings simultaneously obtained with surface and hepatic electrodes. We included 114 consecutive patients (mean age 61.7 ± 10.9 years) admitted to our department for cryoballoon ablation. CMAP was monitored simultaneously with a hepatic catheter and a modified lead I ECG, whilst right phrenic nerve was paced before (stage 1) and during (stage 2) the right-sided freezes. If phrenic threat was detected with hepatic recordings (CMAP amplitude drop >30%) the application was discontinued with forced deflation. The ratio of CMAP/QRS was 4.63 (2.67-9.46) for hepatic and 0.76 (0.55-1.14) for surface ( Both methods are feasible with the same signal stability and amplitude drop precocity during phrenic threats. Clarity and legibility are significantly better with hepatic recording (sharper signals, less far-field QRS). The two main limitations were pacing instability and delay between 30% CMAP decrease and cryoapplication discontinuation.
Sections du résumé
BACKGROUND
BACKGROUND
Compound motor action potential (CMAP) monitoring is a common method used to prevent right phrenic nerve palsy during cryoballoon ablation for atrial fibrillation.
OBJECTIVE
OBJECTIVE
We compared recordings simultaneously obtained with surface and hepatic electrodes.
METHODS
METHODS
We included 114 consecutive patients (mean age 61.7 ± 10.9 years) admitted to our department for cryoballoon ablation. CMAP was monitored simultaneously with a hepatic catheter and a modified lead I ECG, whilst right phrenic nerve was paced before (stage 1) and during (stage 2) the right-sided freezes. If phrenic threat was detected with hepatic recordings (CMAP amplitude drop >30%) the application was discontinued with forced deflation.
RESULTS
RESULTS
The ratio of CMAP/QRS was 4.63 (2.67-9.46) for hepatic and 0.76 (0.55-1.14) for surface (
CONCLUSION
CONCLUSIONS
Both methods are feasible with the same signal stability and amplitude drop precocity during phrenic threats. Clarity and legibility are significantly better with hepatic recording (sharper signals, less far-field QRS). The two main limitations were pacing instability and delay between 30% CMAP decrease and cryoapplication discontinuation.
Identifiants
pubmed: 35211527
doi: 10.3389/fcvm.2022.814026
pmc: PMC8861293
doi:
Types de publication
Journal Article
Langues
eng
Pagination
814026Informations de copyright
Copyright © 2022 Tovmassian, Maille, Koutbi, Hourdain, Martinez, Zabern, Deharo and Franceschi.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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