ECG-Guided Surveillance Technique in Cryoballoon Ablation for Paroxysmal and Persistent Atrial Fibrillation: A Strategy to Prevent From Phrenic Nerve Palsy.
OBJECTIVE
Phrenic nerve palsy (PNP) is still a cause for concern in Cryoballoon ablation (CBA) procedures. New surveillance techniques, such as invasive registration of the compound motor action potential (CMAP), have been thought to prevent the occurrence of PNP. The present study investigates the impact of CMAP surveillance via an alternative and non-invasive ECG-conduction technique during CBA.


METHODS
PVI with CBA was performed in 166 patients suffering from AF. Diaphragmal contraction was monitored by abdominal hands-on observation in Observation Group I; Observation Group II was treated using additional ECG-conduction, as a means of modified CMAP surveillance method. During the ablation of the right superior and inferior pulmonary veins, the upper extremities lead I was newly adjusted between the inferior sternum and the right chest, thereby recording the maximum CMAP. The CMAP in the above-mentioned ECG leads was continuously observed in a semi-quantitative manner.


RESULTS
PNP was observed in 10 (6%) patients in total. In Observation Group I, 6 out of 61 (9.8%) demonstrated PNP. In Observation Group II a significant decrease of PNP could be demonstrated (p <0,001) and occurred in 4 out of 105 patients (3.8%). While three patients from Observation Group I left the EP lap with an ongoing PNP, none of the patients in Observation Group II had persistent PNP outside of the EP lab.


CONCLUSIONS
The present study demonstrates that additional ECG-conduction, used as modified CMAP surveillance, is an easy, effective and helpful additional safety measure to prevent PNP in CBA.
1. Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Merheim, University Witten/Herdecke/Germany Ostmerheimer Str. 200, 51109 Cologne, Germany.
Axel
A
Meissner
1. Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Merheim, University Witten/Herdecke/Germany Ostmerheimer Str. 200, 51109 Cologne, Germany.
Petra
P
Maagh
1. Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Merheim, University Witten/Herdecke/Germany Ostmerheimer Str. 200, 51109 Cologne, Germany.
Arndt
A
Christoph
2. Department of Diagnostic and Interventional Radiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789 Bochum.
Ahmet
A
Oernek
3. Department of Cardiology and Angiology, Johanniter-Krankenhaus Rheinhausen GmbH, Kreuzacker 1-7, 47228 Duisburg, Germany.
Gunnar
G
Plehn
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D010523:Peripheral Nervous System Diseases / Q000517:prevention & control; D010791:Phrenic Nerve / Q000293:injuries*; D011446:Prospective Studies
Atrial Fibrillation; Cryoballoon Ablation, Phrenic Nerve palsy, Compound Motor Action Potential; Pulmonary Vein Isolation