An alternative method for phrenic nerve monitoring during cryoballoon procedures

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-06-01 DOI:10.1016/j.hroo.2025.03.016

Alessio Marinelli MD , Konstantinos Trachanas MD, PhD , Maurizio Corso BD , Davide Fasoli BD , Michele Canton BD , Alessandro Costa MD , Federico Cecchini MD , Stefano Bonapace MD , Alessandro Mantovani MD, PhD , Melania Bonocore MD , Antonino Mignano MD, PhD , Carlo Cicerone MD , Giulio Molon MD, FACC, FESC

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Abstract

Background

Cryoballoon ablation is associated with a consistent risk of phrenic nerve (PN) damage. Abdominal palpation associated with other strategies such as the diaphragmatic compound motor action potential (CMAP) has been shown to be an effective and reliable method for preventing this complication.

Objective

The purpose of this study was to evaluate the diagnostic performance of a new surface CMAP electrodes positioning.

Methods

A total of 150 patients underwent cryoballoon ablation. During the procedure, we placed the CMAP leads per the manufacturer’s instructions and our alternative method, named NeedMAP, by placing electrocardiographic electrodes on the anterior axillary line. We simultaneously recorded the CMAP and the NeedMAP. CMAP monitoring with a 35% decrease cutoff for the diagnosis of nerve threatening was considered the gold standard. The NeedMAP decrease threshold also was set at 35%.

Results

A total of 438 cryoballoon applications were performed on the right pulmonary veins. Mean CMAP amplitude was 0.60 ± 0.33 mV compared to NeedMAP amplitude 0.85 ± 0.46 mV (P <.001). Among the 150 patients, 15 (10%) showed a nerve threat. In our population, the CMAP with regard to nerve damage had sensitivity of 38%, specificity 76%, negative predictive value (NPV) 89%, and positive predictive value (PPV) 19%. The NeedMAP showed sensitivity of 61%, specificity 86%, NPV 93%, and PPV 40%.

Conclusion

The NeedMAP signal for PN monitoring during cryoballoon ablation seems to be a reliable method, shows good sensitivity and specificity, and can help clinicians in preventing PN damage.

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低温球囊术中膈神经监测的另一种方法

低温球囊消融与膈神经（PN）损伤的风险一致相关。腹部触诊联合其他策略，如膈复合运动动作电位（CMAP）已被证明是预防这种并发症的有效和可靠的方法。目的评价一种新型表面CMAP电极定位的诊断性能。方法对150例患者行冷冻球囊消融术。在手术过程中，我们按照制造商的说明放置CMAP导联，我们的替代方法，称为NeedMAP，通过在腋窝前线上放置心电图电极。我们同时记录了CMAP和NeedMAP。CMAP监测下降35%的临界值被认为是诊断神经威胁的金标准。NeedMAP减少阈值也设置为35%。结果右肺静脉低温球囊应用438例。平均CMAP幅值为0.60±0.33 mV， NeedMAP幅值为0.85±0.46 mV （P <.001）。150例患者中有15例（10%）出现神经威胁。在我们的人群中，CMAP对神经损伤的敏感性为38%，特异性为76%，阴性预测值（NPV） 89%，阳性预测值（PPV） 19%。NeedMAP的灵敏度为61%，特异性为86%，NPV为93%，PPV为40%。结论低温球囊消融过程中使用NeedMAP信号监测PN是一种可靠的方法，具有良好的敏感性和特异性，可帮助临床医生预防PN损伤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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