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Review
. 2023 May;9(5):692-696.
doi: 10.1016/j.jacep.2023.01.015. Epub 2023 Mar 22.

Phrenic Relocation by Endoscopy, Intentional Pneumothorax Using Carbon Dioxide, and Single Lung Ventilation (PHRENICS) Technique

Rajan L Shah  1 , Alexander Perino  2 , Paul Wang  2 , Anson Lee  3 , Nitish Badhwar  2
Affiliations
Free article
Review

Phrenic Relocation by Endoscopy, Intentional Pneumothorax Using Carbon Dioxide, and Single Lung Ventilation (PHRENICS) Technique

Rajan L Shah et al. JACC Clin Electrophysiol. 2023 May.
Free article

Abstract

Strategies to prevent right phrenic nerve (PN) injury during catheter ablation can be difficult to employ, ineffective, and risky. A novel PN-sparing technique involving single lung ventilation followed by "intentional pneumothorax" was prospectively evaluated in patients with multidrug refractory periphrenic atrial tachycardia (AT). This hybrid technique, termed PHRENICS (Phrenic Relocation by Endoscopy & Intentional Pneumothorax using Carbon Dioxide & Single Lung Ventilation), resulted in effective PN relocation away from the target site in all cases, allowing successful catheter ablation of AT without procedural complication or arrhythmia recurrence. The PHRENICS hybrid ablation technique can effectively mobilize the PN, avoiding unnecessary invasion of the pericardium, and can expand the safety of catheter ablation for periphrenic AT.

Keywords: hybrid; intentional pneumothorax; phrenic nerve; single lung ventilation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Shah has received honoraria from Abbott for education and consulting fees. Dr Perino has received consulting fees from Medtronic, Biotronik, Abbott, and Haemonetics. Dr Badhwar has received honoraria from Abbott for fellows’ education. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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