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Case Reports
. 2017 Feb 5;3(4):199-204.
doi: 10.1016/j.hrcr.2016.08.012. eCollection 2017 Apr.

Protecting the right phrenic nerve during catheter ablation: Techniques and anatomical considerations

Stephen Stark  1 , David K Roberts  1 , Thomas Tadros  1 , James Longoria  1 , Subramaniam C Krishnan  1
Affiliations
Case Reports

Protecting the right phrenic nerve during catheter ablation: Techniques and anatomical considerations

Stephen Stark et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Balloon inflation; Catheter ablation; Pericardial reflections; Pericardial space; Phrenic nerve injury.

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Figures

Figure 1
Figure 1
A: Intracardiac tracings and 4 surface leads recorded during atrial tachycardia. The earliest atrial activation is seen in the distal pair of electrodes of the ablation catheter (Abl d) positioned in the junction of the superior vena cava and the posterior right atrium. B: A 23° right anterior oblique view showing catheter positions. The ablation catheter (arrow) is positioned at the site of origin of the atrial tachycardia at the junction of the superior vena cava and the posterior right atrium. C: A NavX map of the right and left atria displaying geometry and activation of the atrial tachycardia. The figure on the left shows a right lateral view of the right and left atria, and the figure on the right shows a cranial view. The ablation catheter is seen to be positioned at the site of origin of the arrhythmia (colored in white) at the junction of the superior vena cava and the right atrium.
Figure 1
Figure 1
Continued
Figure 2
Figure 2
A: A 25° right anterior oblique view showing the balloon inflated and positioned in the posterolateral region adjacent to the ablation catheter. Attention is drawn to the position of the wire tip (black arrow), which is halfway between the balloon and the anterior pericardium. Pacing from the ablation catheter (white arrow) with the balloon positioned at this position showed phrenic nerve capture. Ablation was not performed at this position. Note the pericardial sheath looking slightly tortuous, indicating a lack of tension in the balloon catheter. B: A 27° right anterior oblique view showing the balloon inflated and positioned in the posterolateral region adjacent to the ablation catheter. Attention is drawn to the position of the wire tip (black arrow), which is pushed against the anterior limit of the pericardial space and is bent backward. Pacing from the ablation catheter (white arrow) with the balloon positioned at this position showed no phrenic nerve capture. Note the pericardial sheath straightens, indicating tension from forward pressure applied in the balloon catheter. Compared to panel A, the distance between the balloon and the coronary sinus catheter is seen to be substantially greater, indicating a posterior displacement of the balloon. Ablation was performed at this position with successful termination of the arrhythmia. C: Termination of atrial tachycardia seen with application of radiofrequency energy. The application of radiofrequency energy was performed after the sheath maneuver displayed in panel B was performed and pacing from this site demonstrated the absence of phrenic nerve capture. Postablation, the right phrenic nerve was intact and displayed normal function.
See this image and copyright information in PMC

References

    1. Bai R., Patel D., Di Biase L. Phrenic nerve injury after catheter ablation: should we worry about this complication. J Cardiovasc Electrophysiol. 2006;17:944–948. - PubMed
    1. Sacher F., Monahan K.H., Thomas S.P. Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study. J Am Coll Cardiol. 2006;47:2498–2503. - PubMed
    1. Buch E., Vaseghi M., Cesario D.A., Shivkumar K. A novel method for preventing phrenic nerve injury during catheter ablation. Heart Rhythm. 2007;4:95–98. - PMC - PubMed
    1. Matsuo S., Jaïs P., Knecht S., Lim K.T., Hocini M., Derval N., Wright M., Sacher F., Haissaguerre M. Images in cardiovascular medicine: novel technique to prevent left phrenic nerve injury during epicardial catheter ablation. Circulation. 2008;117:e471. - PubMed
    1. Di Biase L., Burkhardt J.D., Pelargonio G. Prevention of phrenic nerve injury during epicardial ablation: comparison of methods for separating the phrenic nerve from the epicardial surface. Heart Rhythm. 2009;6:957–961. - PubMed

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