Arrhythmias & electrophysiologyDiagnostic or prognostic study
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
- Diagnostic accuracy study
- consecutive patients
- CT segmentation merged with electroanatomical map
Authors' 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
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
80.8%
Sensitivity · Specificity 77.5%
RPN-t > 30 mA
68.0%
Sensitivity · Specificity 91.6%
Non-capture at 50 mA
42.4%
Sensitivity · Specificity 97.6%
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:10.1093/europace/euae207
Summarised from the published abstract; every number is checked against it