Quick, safe, and effective maneuver to prevent phrenic nerve injury during cryoballoon ablation of atrial fibrillation
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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.
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.
The average CMAP amplitude significantly decreased from 0.81 ± 0.04 to 0.31 ± 0.21 (p < 0.01) mV during the cryoballoon applications of PVs in 92 PVs. The PBM was employed in all cases, and the average CMAP amplitude recovered to 0.87 ± 0.31 mV (p < 0.01) in 79 out of 92 PVs (85.9%), accomplishing the CBA. Cryofreezing had to be prematurely terminated due to failure of the PBM in 13 out of 92 cases (14.1%).
The PBM was an effective maneuver to prevent PN injury by creating a distance between the PN and location of the cryoballoon. No adverse events were provoked by this procedure.
KeywordsAtrial fibrillation Catheter ablation Cryoballoon Phrenic nerve injury
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 7.Horton R, Di Biase L, Reddy V, Neuzil P, Mohanty P, Sanchez J, et al. Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography: implications for balloon-based procedures. Heart Rhythm. 2010;7:937–94.CrossRefPubMedCentralPubMedGoogle Scholar
- 8.Okishige K, Aoyagi H, Kawaguchi N, Katoh N, Yamashita M, Nakamura T, et al. Novel method for earlier detection of phrenic nerve injury during cryoballoon applications for electrical isolation of pulmonary veins in patients with atrial fibrillation. Heart Rhythm. 2016;13:1810–6.CrossRefPubMedCentralPubMedGoogle Scholar
- 10.Kuhne M, Sticherling C. Cryoballoon ablation for pulmonary vein isolation of atrial fibrillation: a better way to complete the circle. J Innov Card Rhythm Manag. 2011;2:264–70.Google Scholar
- 20.Okishige K, Aoyagi H, Nishimura T, Shigeta T, Keida T, Sasano T, et al. Left phrenic nerve injury during electrical isolation of left-sided pulmonary veins with the second-generation cryoballoon. PACE. (in press)Google Scholar