Efficacy and safety of right neck phrenic nerve pacing in patients undergoing Cryoablation for atrial fibrillation.
Togo Sakai, Masao Takemoto, Yasushi Oginosawa et al.
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In 30 seconds
This randomized controlled study used a within-patient crossover design to assess right phrenic nerve pacing from the neck versus the superior vena cava during cryoablation of right-sided pulmonary veins in 104 patients with atrial fibrillation. Neck pacing was effective and reported as safe in 96 (92%) of patients. Two patients had transient phrenic nerve injury; no permanent phrenic nerve, accessory nerve, supraclavicular nerve, or brachial plexus injuries were reported. Neck obesity and lower compound motor action potentials independently predicted unsuccessful neck pacing.
Key findings
- Neck pacing was effective and safe in 96 (92%) of 104 patients during right superior pulmonary vein cryoablation.
- Two patients experienced transient phrenic nerve injury; no permanent nerve injuries or other listed complications were reported.
- Neck-to-height ratio > 0.252 and lower compound motor action potentials independently predicted unsuccessful neck pacing.
Why it matters
Phrenic nerve pacing is used to help prevent nerve injury during balloon-based ablation of right-sided pulmonary veins. This study suggests that a neck pacing approach can work for many patients, while identifying neck obesity and lower motor response amplitudes as factors associated with failure. These findings inform assessment of feasibility, but do not establish that neck pacing should replace SVC pacing.
What to keep in mind
The study assessed pacing during cryoablation and reports outcomes in 104 patients; the abstract does not provide longer-term follow-up or comparative complication rates between pacing sites.