Arrhythmias & electrophysiology
Value of high-output pace-mapping of the right phrenic nerve for enabling safe radiofrequency ablation of atrial fibrillation: insights from three-dimensional computed tomography segmentation
Performance · Prediction of distance to RPN > 10 mm by RPN-tResult — go to the resultAUC 0.846 CI 0.821–0.870Authors' conclusion
Non-capture at 50 mA/2 ms demonstrated very high specificity for predicting a distance to the RPN > 10 mm, ensuring safe radiofrequency delivery.
Study context
- Population
- Consecutive patients undergoing atrial fibrillation (AF) radiofrequency ablation1,033 pacing sites analysed
- Participants
- 45 patients
- Comparison
- Right phrenic nerve (RPN) capture threshold on high-output pace-mapping vs CT anatomic RPN location
- Outcome
- Distance between endocardial capture sites and CT anatomic RPN location, by capture threshold; prediction of distance >10 mm
Methodological detailsconsecutive patients, CT segmentation merged with electroanatomical map
- Consecutive patients
- CT segmentation merged with electroanatomical map
Performance
Prediction of distance to RPN > 10 mm by RPN-t
AUC
0.846
CI 0.821–0.870
P < 0.001
By group
RPN-t > 20 mA
- Sensitivity
- 80.8%
- Specificity
- 77.5%
RPN-t > 30 mA
- Sensitivity
- 68.0%
- Specificity
- 91.6%
Non-capture at 50 mA
- Sensitivity
- 42.4%
- Specificity
- 97.6%
Sensitivity
RPN-t > 20 mA80.8%
RPN-t > 30 mA68.0%
Non-capture at 50 mA42.4%
Specificity
RPN-t > 20 mA77.5%
RPN-t > 30 mA91.6%
Non-capture at 50 mA97.6%
As reported in the abstract
- Distance pacing site to RPN when RPN-t ≤10 mA
- 7.5 ± 3.0 mm (min 1)
- Distance pacing site to RPN with non-capture at 50 mA
- 19.2 ± 6.5 mm (min 9.4)
Original publication
Value of high-output pace-mapping of the right phrenic nerve for enabling safe radiofrequency ablation of atrial fibrillation: insights from three-dimensional computed tomography segmentation. Europace. Published 31 July 2024. doi:10.
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