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Coronary sinus catheter placement via left cubital vein for phrenic nerve stimulation during pulmonary vein isolation

  • Akio Chikata
  • Takeshi KatoEmail author
  • Kazuo Usuda
  • Shuhei Fujita
  • Michiro Maruyama
  • Kan-ichi Otowa
  • Shin-ichiro Takashima
  • Hisayoshi Murai
  • Soichiro Usui
  • Hiroshi Furusho
  • Shuichi Kaneko
  • Masayuki Takamura
Original Article
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Abstract

Phrenic nerve (PN) stimulation is essential for the elimination of PN palsy during balloon-based pulmonary vein isolation (PVI). Although ultrasound-guided vascular access is safe, insertion of a PN stimulation catheter via central venous access carries a potential risk of the development of mechanical complications. We evaluated the safety of a left cubital vein approach for positioning a 20-electrode atrial cardioversion (BeeAT) catheter in the coronary sinus (CS), and the feasibility of right PN pacing from the superior vena cava (SVC) using proximal electrodes of the BeeAT catheter. In total, 106 consecutive patients who underwent balloon-based PVI with a left cubital vein approach for BeeAT catheter positioning were retrospectively assessed. The left cubital approach was successful in 105 patients (99.1%), and catheter insertion into the CS was possible for 104 patients (99.0%). Among these patients, constant right PN pacing from the SVC was obtained for 89 patients (89/104, 85.6%). In five patients, transient loss of right PN capture occurred during right pulmonary vein ablation. No persistent right PN palsy was observed. Small subcutaneous hemorrhage was observed in eight patients (7.5%). Neuropathy, pseudoaneurysm, arteriovenous fistula, and perforations associated with the left cubital approach were not detected. Body mass index was significantly higher in the right PN pacing failure group than in the right PN pacing success group (26.2 ± 3.2 vs. 23.8 ± 3.8; P = 0.025). CS catheter placement with a left cubital vein approach for right PN stimulation was found to be safe and feasible. Right PN pacing from the SVC using a BeeAT catheter was successfully achieved in the majority of the patients. This approach may prove to be preferable for non-obese patients.

Keywords

Atrial fibrillation Left cubital vein Phrenic nerve stimulation Pulmonary vein isolation 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Akio Chikata
    • 1
    • 2
  • Takeshi Kato
    • 2
    Email author
  • Kazuo Usuda
    • 1
  • Shuhei Fujita
    • 3
  • Michiro Maruyama
    • 1
  • Kan-ichi Otowa
    • 1
  • Shin-ichiro Takashima
    • 2
  • Hisayoshi Murai
    • 2
  • Soichiro Usui
    • 2
  • Hiroshi Furusho
    • 2
  • Shuichi Kaneko
    • 2
  • Masayuki Takamura
    • 2
  1. 1.Division of Cardiology, Department of Internal MedicineToyama Prefectural Central HospitalToyamaJapan
  2. 2.Department of System Biology, School of Advanced Preventive Medical SciencesKanazawa University GraduateKanazawaJapan
  3. 3.Department of PediatricsToyama Prefectural Central HospitalToyamaJapan

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