Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach
BackgroundCompound motor action potential (CMAP) monitoring is a common method used to prevent right phrenic nerve palsy during cryoballoon ablation for atrial fibrillation.ObjectiveWe compared recordings simultaneously obtained with surface and hepatic electrodes.MethodsWe included 114 consecutive...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.814026/full |
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| author | Lilith Tovmassian Lilith Tovmassian Baptiste Maille Baptiste Maille Baptiste Maille Baptiste Maille Linda Koutbi Linda Koutbi Jérôme Hourdain Jérôme Hourdain Elisa Martinez Elisa Martinez Maxime Zabern Maxime Zabern Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi |
| author_facet | Lilith Tovmassian Lilith Tovmassian Baptiste Maille Baptiste Maille Baptiste Maille Baptiste Maille Linda Koutbi Linda Koutbi Jérôme Hourdain Jérôme Hourdain Elisa Martinez Elisa Martinez Maxime Zabern Maxime Zabern Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi |
| author_sort | Lilith Tovmassian |
| collection | DOAJ |
| description | BackgroundCompound motor action potential (CMAP) monitoring is a common method used to prevent right phrenic nerve palsy during cryoballoon ablation for atrial fibrillation.ObjectiveWe compared recordings simultaneously obtained with surface and hepatic electrodes.MethodsWe included 114 consecutive patients (mean age 61.7 ± 10.9 years) admitted to our department for cryoballoon ablation. CMAP was monitored simultaneously with a hepatic catheter and a modified lead I ECG, whilst right phrenic nerve was paced before (stage 1) and during (stage 2) the right-sided freezes. If phrenic threat was detected with hepatic recordings (CMAP amplitude drop >30%) the application was discontinued with forced deflation.ResultsThe ratio of CMAP/QRS was 4.63 (2.67–9.46) for hepatic and 0.76 (0.55–1.14) for surface (p < 0.0001). Signal coefficients of variation during stage 1 were 3.92% (2.48–6.74) and 4.10% (2.85–5.96) (p = 0.2177), respectively. Uninterpretable signals were more frequent on surface (median 10 vs. 0; p < 0.0001). For the 14 phrenic threats, the CMAP amplitude dropped by 35.61 ± 8.27% on hepatic signal and by 33.42 ± 11.58% concomitantly on surface (p = 0.5417). Our main limitation was to achieve to obtain stable phrenic capture (57%). CMAP monitoring was not reliable because of pacing instability in 15 patients (13.16%). A palsy occurred in 4 patients (3.51%) because cryoapplication was halted too late.ConclusionBoth methods are feasible with the same signal stability and amplitude drop precocity during phrenic threats. Clarity and legibility are significantly better with hepatic recording (sharper signals, less far-field QRS). The two main limitations were pacing instability and delay between 30% CMAP decrease and cryoapplication discontinuation. |
| first_indexed | 2024-12-24T02:59:55Z |
| format | Article |
| id | doaj.art-86db7c8e5d5043d08f1bf3642a2eb2c4 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-24T02:59:55Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-86db7c8e5d5043d08f1bf3642a2eb2c42022-12-21T17:18:14ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-02-01910.3389/fcvm.2022.814026814026Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This ApproachLilith Tovmassian0Lilith Tovmassian1Baptiste Maille2Baptiste Maille3Baptiste Maille4Baptiste Maille5Linda Koutbi6Linda Koutbi7Jérôme Hourdain8Jérôme Hourdain9Elisa Martinez10Elisa Martinez11Maxime Zabern12Maxime Zabern13Jean-Claude Deharo14Jean-Claude Deharo15Jean-Claude Deharo16Jean-Claude Deharo17Frédéric Franceschi18Frédéric Franceschi19Frédéric Franceschi20Frédéric Franceschi21Department of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceCenter for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, FranceAix-Marseille University, Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceCenter for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, FranceAix-Marseille University, Marseille, FranceDepartment of Cardiology, CHU Timone, Marseille, FranceAix-Marseille Université, Faculté de Médecine,Marseille, FranceCenter for CardioVascular and Nutrition Research (C2VN), INSERM, INRA, Marseille, FranceAix-Marseille University, Marseille, FranceBackgroundCompound motor action potential (CMAP) monitoring is a common method used to prevent right phrenic nerve palsy during cryoballoon ablation for atrial fibrillation.ObjectiveWe compared recordings simultaneously obtained with surface and hepatic electrodes.MethodsWe included 114 consecutive patients (mean age 61.7 ± 10.9 years) admitted to our department for cryoballoon ablation. CMAP was monitored simultaneously with a hepatic catheter and a modified lead I ECG, whilst right phrenic nerve was paced before (stage 1) and during (stage 2) the right-sided freezes. If phrenic threat was detected with hepatic recordings (CMAP amplitude drop >30%) the application was discontinued with forced deflation.ResultsThe ratio of CMAP/QRS was 4.63 (2.67–9.46) for hepatic and 0.76 (0.55–1.14) for surface (p < 0.0001). Signal coefficients of variation during stage 1 were 3.92% (2.48–6.74) and 4.10% (2.85–5.96) (p = 0.2177), respectively. Uninterpretable signals were more frequent on surface (median 10 vs. 0; p < 0.0001). For the 14 phrenic threats, the CMAP amplitude dropped by 35.61 ± 8.27% on hepatic signal and by 33.42 ± 11.58% concomitantly on surface (p = 0.5417). Our main limitation was to achieve to obtain stable phrenic capture (57%). CMAP monitoring was not reliable because of pacing instability in 15 patients (13.16%). A palsy occurred in 4 patients (3.51%) because cryoapplication was halted too late.ConclusionBoth methods are feasible with the same signal stability and amplitude drop precocity during phrenic threats. Clarity and legibility are significantly better with hepatic recording (sharper signals, less far-field QRS). The two main limitations were pacing instability and delay between 30% CMAP decrease and cryoapplication discontinuation.https://www.frontiersin.org/articles/10.3389/fcvm.2022.814026/fullatrial fibrillationpulmonary vein isolationcryoballoon ablationphrenic nerve palsycompound motor action potential |
| spellingShingle | Lilith Tovmassian Lilith Tovmassian Baptiste Maille Baptiste Maille Baptiste Maille Baptiste Maille Linda Koutbi Linda Koutbi Jérôme Hourdain Jérôme Hourdain Elisa Martinez Elisa Martinez Maxime Zabern Maxime Zabern Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Jean-Claude Deharo Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi Frédéric Franceschi Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach Frontiers in Cardiovascular Medicine atrial fibrillation pulmonary vein isolation cryoballoon ablation phrenic nerve palsy compound motor action potential |
| title | Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach |
| title_full | Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach |
| title_fullStr | Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach |
| title_full_unstemmed | Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach |
| title_short | Diaphragmatic CMAP Monitoring During Cryoballoon Procedures: Surface vs. Hepatic Recording Comparison and Limitations of This Approach |
| title_sort | diaphragmatic cmap monitoring during cryoballoon procedures surface vs hepatic recording comparison and limitations of this approach |
| topic | atrial fibrillation pulmonary vein isolation cryoballoon ablation phrenic nerve palsy compound motor action potential |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.814026/full |
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