Marinelli Alessio, Trachanas Konstantinos, Corso Maurizio, Fasoli Davide, Canton Michele, Costa Alessandro, Cecchini Federico, Bonapace Stefano, Mantovani Alessandro, Bonocore Melania, Mignano Antonino, Cicerone Carlo, Molon Giulio
AOOR Villa Sofia-Cervello, Villa Sofia Cardiology Department, Palermo, Italy.
IRCCS Sacro Cuore-Don Calabria, Department of Cardiology, Negrar di Valpolicella, Verona, Italy.
Heart Rhythm O2. 2025 Mar 30;6(6):739-744. doi: 10.1016/j.hroo.2025.03.016. eCollection 2025 Jun.
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.
The purpose of this study was to evaluate the diagnostic performance of a new surface CMAP electrodes positioning.
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%.
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 ( <.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%.
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.
冷冻球囊消融术存在膈神经（PN）损伤的持续风险。与其他策略（如膈肌复合运动动作电位（CMAP））相关的腹部触诊已被证明是预防这种并发症的有效且可靠的方法。
本研究的目的是评估一种新的表面CMAP电极定位的诊断性能。
共有150例患者接受冷冻球囊消融术。在手术过程中，我们按照制造商的说明放置CMAP导联，并通过将心电图电极放置在腋前线来采用我们的替代方法，即NeedMAP。我们同时记录CMAP和NeedMAP。以CMAP监测下降35%作为神经受威胁诊断的截断值被视为金标准。NeedMAP下降阈值也设定为35%。
共对右肺静脉进行了438次冷冻球囊应用。平均CMAP幅度为0.60±0.33 mV，而NeedMAP幅度为0.85±0.46 mV（P<0.001）。在150例患者中，15例（10%）显示神经受威胁。在我们的研究人群中，CMAP对于神经损伤的敏感性为38%，特异性为76%，阴性预测值（NPV）为89%，阳性预测值（PPV）为19%。NeedMAP的敏感性为61%，特异性为86%，NPV为93%，PPV为40%。
冷冻球囊消融术中用于监测PN的NeedMAP信号似乎是一种可靠的方法，具有良好的敏感性和特异性，可帮助临床医生预防PN损伤。
