Determination of the best electrode position for recording of the diaphragm compound muscle action potential

Dionne, Annie; Parkes, Anthony; Engler, Beata; Watson, Bradley V.; Nicolle, Michael W.

doi:10.1002/mus.21290

Cited by 28 publications

(36 citation statements)

References 10 publications

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“…First, a major pacing artifact limited recording to a small terminal segment of the CMAP. Second, CMAP amplitude showed variations of 30% with respiratory movements, 5 that is, the exact value of the cutoff for discontinuing cryoablation observed in the animal study. Third, placement of electrodes for effective recording was challenging, particularly in obese patients.…”

Section: Clinical Perspective On P 1114mentioning

confidence: 75%

Novel Electromyographic Monitoring Technique for Prevention of Right Phrenic Nerve Palsy During Cryoballoon Ablation

Franceschi

Koutbi

Mancini

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Right phrenic nerve palsy (PNP) is the most frequent complication of cryoballoon ablation. Diaphragmatic electromyography can predict PNP with a comfortable safety margin. Our goal was to evaluate the feasibility, efficacy, and safety of electromyography-guided PN monitoring using a novel hepatic vein approach for prevention of PNP. Methods and Results-This study includes 57 patients (47 males) indicated for cryoballoon ablation for treatment of atrial fibrillation. During right superior pulmonary vein ablation, the PN was paced at 60 beats per minute and diaphragmatic compound motor action potential (CMAP) amplitude was recorded via a quadripolar catheter positioned in a subdiaphragmatic hepatic vein. If a 30% drop in CMAP amplitude was observed, ablation was discontinued with forced deflation. Reliable recording of CMAP before ablation was feasible in 50 of 57 patients (88%). In 7 patients (12%), stable PN pacing could not be achieved. In 44 of 50 patients, CMAP amplitude remained constant during cryoapplication. The mean value of CMAP amplitude was 639.7±240.5 µV; mean variation was 13±4.3%. In 6 of 50 patients (12%) including 5 treated with a 23-mm cryoballoon and 1 with a 28-mm cryoballoon, the 30% reduction cutoff was reached and cryoablation was discontinued. Recovery of CMAP amplitude after discontinuing cryoablation took <60 seconds in all cases. No PNP or complication related to PN monitoring occurred. Conclusions-Recording of diaphragmatic CMAP using a catheter positioned in a subdiaphragmatic hepatic vein seems feasible during cryoballoon ablation. Electromyography-guided PN monitoring seems safe and potentially helpful for prevention of PNP. (Circ Arrhythm Electrophysiol. 2013;6:1109-1114.)

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Section: Clinical Perspective On P 1114mentioning

confidence: 75%

Novel Electromyographic Monitoring Technique for Prevention of Right Phrenic Nerve Palsy During Cryoballoon Ablation

Franceschi

Koutbi

Mancini

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…Per our previously described methodology, 2 standard surface electrodes were positioned on the right hemithorax to record a right diaphragmatic CMAP; the first 5 cm above the xiphoid process and the second 16 cm away along the right costal margin (Figure 1). 12,13 These electrodes were connected to a central computerized electrophysiology workstation (EP Med Systems, St Jude Medical, or Prucka recording system, GE Healthcare) where bipolar electromyography signals were amplified and band-pass filtered between 1 and 50 Hz.…”

Section: Diaphragmatic Stimulation and Cmap Monitoringmentioning

confidence: 99%

Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation

Mondésert

Andrade

Khairy

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Phrenic nerve palsy remains the most frequent complication associated with cryoballoon-based pulmonary vein (PV) isolation. We sought to characterize our experience using a novel monitoring technique for the prevention of phrenic nerve palsy. Methods and Results-Two hundred consecutive cryoballoon-based PV isolation procedures between October 2010and October 2013 were studied. In addition to standard abdominal palpation during right phrenic nerve pacing from the superior vena cava, all patients underwent diaphragmatic electromyographic monitoring using surface electrodes. Cryoablation was terminated on any perceived reduction in diaphragmatic motion or a 30% decrease in the compound motor action potential (CMAP). During right-sided ablation, a ≥30% reduction in CMAP amplitude occurred in 49 patients (24.5%). Diaphragmatic motion decreased in 30 of 49 patients and was preceded by a 30% reduction in CMAP amplitude in all. In 82% of cases, this reduction in CMAP amplitude occurred during right superior PV isolation. The baseline CMAP amplitude was 946.5±609.2 mV and decreased by 13.8±13.8% at the end of application. This decrease was more marked in the 33 PVs with a reduction in diaphragmatic motion than in those without (40.9±15.3% versus 11.3±10.5%; P<0.001). In 3 cases, phrenic nerve palsy persisted beyond the end of the procedure, with all cases recovering within 6 months. Despite the shortened application all veins were isolated. At repeat procedure the right-sided PVs reconnected less frequently than the left-sided PVs in those with phrenic nerve palsy. Conclusions-Electromyographic phrenic nerve monitoring using the surface CMAP is reliable, easy to perform, and offers an early warning to impending phrenic nerve injury. (Circ Arrhythm Electrophysiol. 2014;7:605-611.)

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“…Maintenance of a similar relaxed posture, including thoracoabdominal conWguration (Chen et al 2000), is also critical because pressure responses to PNS depend on the load the diaphragm acts against, and therefore on the mechanical characteristics of the rib cage and abdominal wall. The phrenic nerve is usually found underneath the posterior border of the sternocleidomastoid muscle, at the level of the cricoid cartilage (Dionne et al 2009). Maintaining optimal contact between the stimulating electrode and the nerve can be diYcult and it may be necessary to impose a signiWcant degree of pressure on the soft tissues of the neck which can be painful for subjects.…”

Section: Use Of Electrical Stimulation To Assess Inspiratory and Expimentioning

confidence: 99%

Electrical stimulation for testing neuromuscular function: from sport to pathology

et al. 2011

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The use of electrical stimulation (ES) can contribute to our knowledge of how our neuromuscular system can adapt to physical stress or unloading. Although it has been recently challenged, the standard technique used to explore central modifications is the twitch interpolated method which consists in superimposing single twitches or high-frequency doublets on a maximal voluntary contraction (MVC) and to compare the superimposed response to the potentiated response obtained from the relaxed muscle. Alternative methods consist in (1) superimposing a train of stimuli (central activation ratio), (2) comparing the MVC response to the force evoked by a high-frequency tetanus or (3) examining the change in maximal EMG response during voluntary contractions, if this variable is normalized to the maximal M wave, i.e. EMG response to a single stimulus. ES is less used to examine supraspinal factors but it is useful for investigating changes at the spinal level, either by using H reflexes, F waves or cervicomedullary motor-evoked potentials. Peripheral changes can be examined with ES, usually by stimulating the muscle in the relaxed state. Neuromuscular propagation of action potentials on the sarcolemma (M wave, high-frequency fatigue), excitation-contraction coupling (e.g. low-frequency fatigue) and intrinsic force (high-frequency stimulation at supramaximal intensity) can all be used to non-invasively explore muscular function with ES. As for all indirect methods, there are limitations and these are discussed in this review. Finally, (1) ES as a method to measure respiratory muscle function and (2) the comparison between electrical and magnetic stimulation will also be considered.

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Determination of the best electrode position for recording of the diaphragm compound muscle action potential

Cited by 28 publications

References 10 publications

Novel Electromyographic Monitoring Technique for Prevention of Right Phrenic Nerve Palsy During Cryoballoon Ablation

Novel Electromyographic Monitoring Technique for Prevention of Right Phrenic Nerve Palsy During Cryoballoon Ablation

Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation

Electrical stimulation for testing neuromuscular function: from sport to pathology

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