Prospective Evaluation of Electromyography-Guided Phrenic Nerve Monitoring During Superior Vena Cava Isolation to Anticipate Phrenic Nerve Injury

Autor:	Yoshito Iesaka, Akio Kuroi, Takamitsu Takagi, Noboru Ichihara, Hiroaki Nakamura, Hiroshi Taniguchi, Kenzo Hirao, Jin Iwasawa, Hitoshi Hachiya, Makoto Araki, Shinsuke Miyazaki
Rok vydání:	2016
Předmět:	medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Catheter ablation Electromyography 030204 cardiovascular system & hematology Phrenic Nerve Injury Pulmonary vein Compound muscle action potential 03 medical and health sciences 0302 clinical medicine Superior vena cava Physiology (medical) Internal medicine Anesthesia medicine Cardiology 030212 general & internal medicine Electrical conduction system of the heart Cardiology and Cardiovascular Medicine business Phrenic nerve
Zdroj:	Journal of Cardiovascular Electrophysiology. 27:390-395
ISSN:	1045-3873
Popis:	Background: Right phrenic nerve injury (PNI) is a major concern during superior vena cava (SVC) isolation due to the anatomical close proximity. The functional and histological severity of PNI parallels the degree of the reduction in the compound motor action potential (CMAP) amplitude. This study aimed to evaluate the feasibility of monitoring CMAPs during SVC isolation to anticipate PNI during atrial fibrillation (AF) ablation. Methods: Thirty-nine paroxysmal AF patients were prospectively enrolled. Radiofrequency energy was delivered point-by-point for 30 seconds with 20 W until eliminating all SVC potentials after the pulmonary vein isolation. Right diaphragmatic CMAPs were obtained from modified surface electrodes by pacing from the right subclavian vein. Radiofrequency applications were applied without fluoroscopy under CMAP monitoring at sites with phrenic nerve capture by high output pacing. Results: Electrical SVC isolation was successfully achieved with a mean of 9.4 ± 3.3 applications in all patients. In 3 (7.5%) patients, the SVC was isolated without radiofrequency delivery at phrenic nerve capture sites. Among a total of 346 applications in the remaining 36 patients, 71 (20.5%) were delivered while monitoring CMAPs. In 1 (1.4%) application, the RF application was interrupted due to a decrease in the CMAP amplitude. However, no PNI was detected on fluoroscopy, and the decreased amplitude recovered spontaneously. The remaining 70 (98.6%) applications exhibited no significant changes in the CMAP amplitude throughout the applications (from 1.01 ± 0.47 to 0.98 ± 0.45 mV, P = 0.383). Conclusions: Stable right diaphragmatic CMAPs could be obtained, and monitoring CMAPs might be useful for anticipating right PNI during SVC isolation.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::9e3f1cefae466a1b801e862ed718a9ba https://doi.org/10.1111/jce.12912 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.