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
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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. / Anwar, Omar; Gunawardene, Melanie A; Dickow, Jannis; Scherschel, Katharina; Jungen, Christiane; Münkler, Paula; Eickholt, Christian; Willems, Stephan; Gessler, Nele; Meyer, Christian.
in: PLOS ONE, Jahrgang 15, Nr. 6, e0235132, 06.2020.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - 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
AU - Anwar, Omar
AU - Gunawardene, Melanie A
AU - Dickow, Jannis
AU - Scherschel, Katharina
AU - Jungen, Christiane
AU - Münkler, Paula
AU - Eickholt, Christian
AU - Willems, Stephan
AU - Gessler, Nele
AU - Meyer, Christian
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - Action Potentials
KW - Aged
KW - Atrial Fibrillation/physiopathology
KW - Cryosurgery/adverse effects
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Intraoperative Neurophysiological Monitoring
KW - Male
KW - Middle Aged
KW - Phrenic Nerve/injuries
KW - Pulmonary Veins/physiopathology
U2 - 10.1371/journal.pone.0235132
DO - 10.1371/journal.pone.0235132
M3 - SCORING: Journal article
C2 - 32584880
VL - 15
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 6
M1 - e0235132
ER -