PMID- 25488959
OWN - NLM
STAT- MEDLINE
DCOM- 20160217
LR  - 20220409
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Linking)
VI  - 17
IP  - 6
DP  - 2015 Jun
TI  - Subclavian vein pacing and venous pressure waveform measurement for phrenic nerve 
      monitoring during cryoballoon ablation of atrial fibrillation.
PG  - 884-90
LID - 10.1093/europace/euu341 [doi]
AB  - AIMS: The phrenic nerves may be damaged during catheter ablation of atrial 
      fibrillation. Phrenic nerve function is routinely monitored during ablation by 
      stimulating the right phrenic nerve from a site in the superior vena cava (SVC) 
      and manually assessing the strength of diaphragmatic contraction. However the 
      optimal stimulation site, method of assessing diaphragmatic contraction, and 
      techniques for monitoring the left phrenic nerve have not been established. We 
      assessed novel techniques to monitor phrenic nerve function during cryoablation 
      procedures. METHODS AND RESULTS: Pacing threshold and stability of phrenic nerve 
      capture were assessed when pacing from the SVC, left and right subclavian veins. 
      Femoral venous pressure waveforms were used to monitor the strength of 
      diaphragmatic contraction. Stable capture of the left phrenic nerve by 
      stimulation in the left subclavian vein was achieved in 96 of 100 patients, with 
      a median capture threshold of 2.5 mA [inter-quartile range (IQR) 1.4-5.0 mA]. 
      Stimulation of the right phrenic nerve from the subclavian vein was superior to 
      stimulation from the SVC with lower pacing thresholds (1.8 mA IQR 1.4-3.3 vs. 6.0 
      mA IQR 3.4-8.0, P < 0.001). Venous pressure waveforms were obtained in all 
      patients and attenuation of the waveform was always observed prior to onset of 
      phrenic nerve palsy. CONCLUSION: The left phrenic nerve can be stimulated from 
      the left subclavian vein. The subclavian veins are the optimal sites for phrenic 
      nerve stimulation. Monitoring the femoral venous pressure waveform is a novel 
      technique for detecting impending phrenic nerve damage.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author 2014. For permissions please email: journals.permissions@oup.com.
FAU - Ghosh, Justin
AU  - Ghosh J
AD  - The Mater Hospital, Sydney, Australia The Royal Prince Alfred Hospital and 
      University of Sydney, Sydney, Australia.
FAU - Singarayar, Suresh
AU  - Singarayar S
AD  - The Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
FAU - Kabunga, Peter
AU  - Kabunga P
AD  - The Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
FAU - McGuire, Mark A
AU  - McGuire MA
AD  - The Mater Hospital, Sydney, Australia The Royal Prince Alfred Hospital and 
      University of Sydney, Sydney, Australia mark.mcguire@email.cs.nsw.gov.au.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141208
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Atrial Fibrillation/*surgery
MH  - Cardiac Pacing, Artificial/methods
MH  - Cohort Studies
MH  - Cryosurgery/adverse effects/methods
MH  - Diaphragm/*innervation
MH  - Electric Stimulation
MH  - Femoral Vein/*physiology
MH  - Humans
MH  - Monitoring, Intraoperative/*methods
MH  - Muscle Contraction/*physiology
MH  - Peripheral Nerve Injuries/*prevention & control
MH  - Phrenic Nerve/injuries/*physiology
MH  - Pulse Wave Analysis
MH  - *Subclavian Vein
MH  - Vena Cava, Superior
MH  - Venous Pressure/*physiology
OTO - NOTNLM
OT  - Atrial fibrillation
OT  - Cryoballoon
OT  - Phrenic nerve palsy
EDAT- 2014/12/10 06:00
MHDA- 2016/02/18 06:00
CRDT- 2014/12/10 06:00
PHST- 2014/08/11 00:00 [received]
PHST- 2014/11/03 00:00 [accepted]
PHST- 2014/12/10 06:00 [entrez]
PHST- 2014/12/10 06:00 [pubmed]
PHST- 2016/02/18 06:00 [medline]
AID - euu341 [pii]
AID - 10.1093/europace/euu341 [doi]
PST - ppublish
SO  - Europace. 2015 Jun;17(6):884-90. doi: 10.1093/europace/euu341. Epub 2014 Dec 8.