Okishige Kaoru, Aoyagi Hideshi, Shigeta Takatoshi, Nakamura Rena A, Nishimura Takuro, Yamauchi Yasuteru, Keida Takehiko, Sasano Tetsuo, Hirao Kenzo
Heart Center, Japan Red Cross Yokohama City Bay Hospital, 1-12-3 Shinyamashita, Naka-ward, Yokohama city, Japan.
Division of Cardiology, Edogawa Hospital, Tokyo, Japan.
J Interv Card Electrophysiol. 2018 Nov;53(2):233-238. doi: 10.1007/s10840-018-0379-2. Epub 2018 May 24.
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.
膈神经（PN）损伤是肺静脉冷冻球囊消融术（CBA）的典型并发症。在膈神经起搏期间通过触诊腹部来监测膈神经功能，当识别到膈肌运动减弱时过早终止冷冻。本研究旨在探讨一种“回撤”操作预防膈神经损伤的有效性和安全性。
共纳入284例患者，在冷冻球囊进行肺静脉（PV）隔离时，通过记录膈神经复合运动动作电位（CMAP）来监测膈神经功能。当CMAP波幅较对照降低超过30%时，采取“回撤”操作（PBM）以预防膈神经损伤。
在92条肺静脉进行冷冻球囊消融时，CMAP平均波幅从0.81±0.04 mV显著降至0.31±0.21 mV（p<0.01）。所有病例均采用了PBM，92条肺静脉中的79条（85.9%）CMAP平均波幅恢复至0.87±0.31 mV（p<0.01），完成了CBA。92例中有13例（14.1%）因PBM失败不得不过早终止冷冻。
PBM是一种有效的操作，可通过在膈神经与冷冻球囊位置之间制造距离来预防膈神经损伤。该操作未引发不良事件。
