RESUMO
PURPOSE: Phrenic nerve injury (PNI) is one of the important complications during cryoballoon (CB) ablation. Recording diaphragmatic compound motor action potentials (CMAPs) during CB ablation can predict PNI. CMAP monitoring may be inaccurate when CMAP amplitudes are low. We examined the effect of positioning an electrocardiography (ECG) electrode at the dorsal side. METHODS: We retrospectively analyzed the cases of 197 consecutive patients who underwent CB ablation for pulmonary vein isolation (PVI) (April 2016 to December 2018) at our institution. CMAP amplitudes were monitored using two recording methods just before cryoapplication. (a) Conventional method: right-arm ECG electrode positioned 5 cm above the xiphoid on the ventral side; left-arm ECG electrode positioned along the costal margin. (b) Our original method: right-arm electrode positioned 5 cm above the xiphoid on the dorsal side; left-arm electrode positioned along the costal margin. RESULTS: The CMAP amplitude during right phrenic nerve pacing was significantly higher at the dorsal side than the ventral side (0.80 ± 0.31 mV vs 0.66 ± 0.29 mV, P < .01). Similarly, the CMAP amplitude during left phrenic nerve pacing was significantly higher at the dorsal side than the ventral side (0.92 ± 0.39 mV, 0.73 ± 0.37 mV, P < .01). PNI occurred in six patients (3.0%); three patients experienced transient PNI, another three patients experienced persistent PNI, and none developed permanent PNI. CONCLUSIONS: CMAP amplitudes were significantly high at the dorsal side compared to the ventral side. Monitoring phrenic nerve function using an ECG electrode at the dorsal side is a simple and easy procedure.
RESUMO
Aprepitant is a NK1 receptor-antagonist with a novel mechanism of action for chemotherapy-induced nausea and vomiting (CINV), and is recommended as a prophylactic by many international and domestic guidelines. However, domestic clinical trials of aprepitant have only been conducted using a single dose in patients who were treated with cisplatin(CDDP), and there is no evidence to support administration of aprepitant in divided doses. We administered aprepitant in divided doses to patients who were also being treated with cisplatin, ifosfamide, and irinotecan(CIC), and had CINV due to prophylactic administration of a 5-HT3 receptor antagonist and dexamethasone. This was done in order to evaluate the antiemetic effect of aprepitant. The patients with"No vomiting"increased significantly from 25% to 83%, and the"Days with nausea"in patients also decreased significantly. Consequently, administration of aprepitant in addition to current antiemetic therapy in divided doses, as well as in single doses, exhibited a greater antiemetic effect in CDDP-treated patients.
