Fluoroscopy of Spontaneous Breathing is More Sensitive Than Phrenic Nerve Stimulation for Detection of Right Phrenic Nerve Injury During Cryoballoon Ablation of Atrial Fibrillation

2014 ◽  
Vol 25 (8) ◽  
pp. 859-865 ◽  
Author(s):  
MARKUS LINHART ◽  
ANNIKA NIELSON ◽  
RENÉ P. ANDRIÉ ◽  
ERICA L. MITTMANN-BRAUN ◽  
FLORIAN STÖCKIGT ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Spontaneous Breathing ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Stimulation ◽  
Phrenic Nerve Injury

Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury

Heart Rhythm ◽  
2014 ◽  
Vol 11 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Mayur Lakhani ◽  
Faisul Saiful ◽  
Valay Parikh ◽  
Nikhil Goyal ◽  
Soad Bekheit ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Phrenic Nerve ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Injury

Quick, safe, and effective maneuver to prevent phrenic nerve injury during cryoballoon ablation of atrial fibrillation

2018 ◽  
Vol 53 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Kaoru Okishige ◽  
Hideshi Aoyagi ◽  
Takatoshi Shigeta ◽  
Rena A. Nakamura ◽  
Takuro Nishimura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Phrenic Nerve ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Injury

scholarly journals INCIDENCE AND PREDICTORS OF COMPLICATIONS AND PHRENIC NERVE INJURY DURING CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION

2016 ◽  
Vol 67 (13) ◽  
pp. 759
Author(s):  
Emily Guhl ◽  
Donald Siddoway ◽  
Evan Adelstein ◽  
Andrew Voigt ◽  
Samir Saba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Phrenic Nerve ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Injury

Clinical feasibility of pulmonary vein orifice pacing for the prediction of phrenic nerve injury during cryoballoon ablation of atrial fibrillation

2019 ◽  
Vol 30 (8) ◽  
pp. 1200-1206
Author(s):  
Makoto Sano ◽  
Tsuyoshi Urushida ◽  
Gaku Matsukura ◽  
Tomoaki Sakakibara ◽  
Kenichiro Suwa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Pulmonary Vein ◽  
Phrenic Nerve ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Injury

scholarly journals A simple method to detect phrenic nerve impairment during cryoballoon ablation of atrial fibrillation using aVF in the standard surface ECG

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Schaerli ◽  
S Knecht ◽  
F Spies ◽  
A Madaffari ◽  
S Osswald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nerve Injury ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy ◽  
Phrenic Nerve Injury ◽  
Surface Ecg ◽  
The Mean ◽  
The Right

Abstract Background Phrenic nerve palsy (PNP) is the most common complication in cryoballoon ablation of atrial fibrillation. Monitoring techniques such as compound motor action potential (CMAP) measurements using additional leads, or catheters positioned in the subdiaphragmatic hepatic vein or the esophagus have demonstrated to be effective to prevent PNP. Purpose This study investigates the safety and feasibility of a simple monitoring strategy using the lead aVF of the standard surface 12 lead ECG for CMAP monitoring to prevent PNP. Methods In 263 continuous patients undergoing cryoballoon ablation, a decapolar catheter was placed in the right subclavian vein to stimulate the phrenic nerve during ablation of the right sided pulmonary veins ([email protected] ms at 60 bpm). Capture was continuously monitored using the CMAP potential in the inferior aVF lead of the surface ECG and manually by palpation of the abdominal movement. The freeze was terminated early if the amplitude of the aVF signal decrease by >25% in three consecutive beats or if the diaphragmatic contraction decreased. Results Phrenic nerve injury documented by a reduction of the signal in aVF was observed in 13 of the 263 patients (5%) during freezes of the right superior pulmonary vein. Reduced diaphragmatic contraction detected by palpation of the abdomen was never observed without previous reduced amplitude in the surface aVF signal and was therefore never the trigger to stop a freeze. In patients with phrenic nerve injury, the mean initial amplitude was 1mV (SD ±0.3mV) and the mean minimal amplitude was 0.3mV (SD ±0.2mV). Mean time to recovery of the aVF amplitude was 160 seconds. Twelve patients (4.6%) showed complete recovery whereas one patient (0.4%) showed only partial recovery, as demonstrated in a sniff test at the end of the procedure. This patient showed no clinical signs of phrenic nerve palsy the following day, and full recovery was demonstrated in a sniff test 3 months later. Conclusion Monitoring of CMAP using the aVF signal from a standard 12-lead ECG during phrenic nerve stimulation to reduce the incidence of phrenic nerve palsy is safe and feasible. This technique is readily available during every standard ablation without placing additional electrodes and more sensitive than manual palpation. aVF signal before and during ablation Funding Acknowledgement Type of funding source: None

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