Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon

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• 作者：Erwin Strö ; ker ; MD^* ; ^{strokerwin@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Carlo de Asmundis ; MD ; PhD ; FHRS^* ; Yukio Saitoh ; MD^* ; Vedran Velagić ; MD^* ; Giacomo Mugnai ; MD^* ; Ghazala Irfan ; MD^* ; Burak Hü ; nü ; k ; MD^* ; Kaoru Tanaka ; MD ; PhD^&dagger ; ; Dries Belsack ; MD^&dagger ; ; Ronald Buyl ; PhD^&Dagger ; ; Pedro Brugada ; MD ; PhD^* ; Gian-Battista Chierchia ; MD ; PhD^*
• 关键词：AF ; atrial fibrillation ; BMI ; body mass index ; CB ; cryoballoon ; CT ; computed tomography ; EB ; early branching ; LA ; left atrium ; PN ; phrenic nerve ; PNI ; phrenic nerve injury ; PV ; pulmonary vein ; PVI ; pulmonary vein isolation ; RCT ; right common trunk ; RF ; radiofrequency ; RIPV ; right inferior pulmonary vein ; RSPV ; right superior pulmonary vein ; SVC ; superior vena cava
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：342-351
• 全文大小：1402 K

文摘

Phrenic nerve injury (PNI) is the most frequently observed complication during pulmonary vein (PV) isolation using the second-generation cryoballoon.

Objective

The purpose of this study was to analyze anatomic predictors based on preprocedural computed tomographic imaging data.

Methods

Forty-one patients with PNI during the procedure and 123 age-, gender-, and body mass index–matched controls were included. A total of 343 right PVs were evaluated for axial/coronal orientation, ostial diameters with cross-sectional area, ovality index, and branching pattern. External angle between the right superior pulmonary vein (RSPV) and the anterolateral wall of the left atrium (LA) was measured (RSPV–LA angle). Distance from this vertex to the superior vena cava (SVC) was considered the RSPV–SVC distance.

Results

For the RSPV, more anterosuperior orientation, larger dimensions, shorter RSPV–SVC distance, and more obtuse RSPV–LA angle (all P <.001) were associated with PNI on univariate analysis. Independent variables after multivariable analysis were RSPV–LA angle (odds ratio 1.03 per degree, 95% confidence interval 1.01–1.04, P <.001) and RSPV area (odds ratio 1.2 per mm², 95% confidence interval 1.1–1.3, P <.001), with a cutoff value ≥141° for RSPV–LA angle (91% sensitivity, 85% specificity) and ≥275 mm² for RSPV area (88% sensitivity, 85% specificity). RIPV area was an independent predictor for PNI at RIPV. A right-sided long common trunk was seen exclusively in 3 patients in the PNI group.

Conclusion

Preprocedural anatomic assessment of right PVs is useful in evaluating the risk of PNI. Ostial vein area and external RSPV–LA angle measurement showed excellent predictive value for PNI at the RSPV.