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

• Published in: Journal of interventional cardiac electrophysiology 2018-11, Vol.53 (2), p.233-238
• Main Authors: Okishige, Kaoru, Aoyagi, Hideshi, Shigeta, Takatoshi, Nakamura, Rena A., Nishimura, Takuro, Yamauchi, Yasuteru, Keida, Takehiko, Sasano, Tetsuo, Hirao, Kenzo
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Back injuries; Cardiac Catheters; Cardiology; Cohort Studies; Cryosurgery - adverse effects; Cryosurgery - methods; Diaphragm; Female; Fibrillation; Fluoroscopy - methods; Freezing; Humans; Injury prevention; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative - methods; Operative Time; Patient Safety; Peripheral Nerve Injuries - etiology; Peripheral Nerve Injuries - prevention & control; Phrenic nerve; Phrenic Nerve - injuries; Pulmonary Veins - surgery; Treatment Outcome
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-018-0379-2

Purpose Phrenic nerve (PN) injury is a typical complication of cryoballoon ablation (CBA) of pulmonary veins. The PN function is monitored by palpating the abdomen during PN pacing, and freezing is prematurely terminated when a reduction in the diaphragm movement is recognized. This study aimed to investigate the efficacy and safety of a “pull-back” maneuver to prevent PN injury. Methods A total of 284 patients were included, and the PN function was monitored by recording the diaphragmatic compound motor action potentials (CMAP) during the cryoballoon applications for pulmonary vein (PV) isolation. When the CMAP amplitude was reduced by more than 30% compared to the control, the “pull-back” maneuver (PBM) was undertaken to prevent PN injury. Results The average CMAP amplitude significantly decreased from 0.81 ± 0.04 to 0.31 ± 0.21 ( p