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Case Reports
. 2019 Jul 20;5(9):480-484.
doi: 10.1016/j.hrcr.2019.07.007. eCollection 2019 Sep.

Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide

Rajan L Shah  1 , Alexander Perino  1 , Oluwatomisin Obafemi  2 , Anson Lee  2 , Nitish Badhwar  1
Affiliations
Case Reports

Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide

Rajan L Shah et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Carbon dioxide insufflation; Catheter ablation; Hybrid; Intentional pneumothorax; Phrenic nerve.

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Figures

Figure 1
Figure 1
A: Ventricular-overdrive pacing during clinical tachycardia with (1) V-A-A-V response and (2) distinct atrial activation sequences and P-wave morphologies between clinical tachycardia and pacing. B: Activation mapping during clinical tachycardia with (1) white outline denoting earliest activation, (2) purple tags denoting locations of phrenic nerve capture, and (3) light green tags denoting ineffective cryoablation lesions and dark green tag denoting cryoablation lesion that resulted in temporary dampening of diaphragmatic excursion. C: Attempted phrenic nerve displacement through percutaneous subxyphoid pericardial instrumentation with (1) an 8.5 French steerable sheath and a steerable catheter, (2) placeholder J wire for a second pericardial access, and (3) endovascular 4 mm mapping/ablation catheter, duodecapolar catheter (DD) for phrenic nerve pacing, and decapolar coronary sinus catheter (CS). d = distal; HIS = His bundle catheter; m = mid; p = proximal; RVA = right ventricular apex catheter.
Figure 2
Figure 2
Thoracoscopic image of heart (H), lung (L), diaphragm (D), and posteriorly displaced phrenic nerve (PN) after intentional pneumothorax with carbon dioxide insufflation.
Figure 3
Figure 3
A: Earliest activation during clinical tachycardia (white tag) and phrenic nerve capture locations with right lung collapsed (black tags) after carbon dioxide insufflation. B: Ablation lesions with termination of tachycardia (red tags). Black tags and orange tags denote phrenic nerve capture locations with and without collapsed lung, respectively.
See this image and copyright information in PMC

References

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