The advent of innovative, potent ablative technologies and the adoption of endo–epicardial
approaches to treat various arrhythmias have engendered a need for developing strategies
to prevent collateral damage to critical structures such as the phrenic nerve (PN)
and the esophagus during percutaneous electrophysiologic interventions. Here we detail
phrenic nerve injury (PNI) prevention strategies during atrial fibrillation (AF),
atrial tachycardia (AT), and ventricular tachycardia (VT) ablation. PNI is more common
on the right side because of the anatomic course of the nerve and the greater preponderance
of AF and AT ablations. PNI also is more common with cryoballoon ablation (nearly
10% in large multicenter trials) than it is with radiofrequency ablation (RFA); thus,
the crux of this discussion is centered on strategies to prevent right PNI during
cryoballoon ablation for AF. However, the expanded scope of this article includes
strategies to prevent both right and left PN injury with interventional electrophysiologic
procedures.
Abbreviations:
AF (atrial fibrillation), AT (atrial tachycardia), CMAP (compound motor action potential), ICE (intracardiac echocardiography), LV (left ventricle), PN (phrenic nerve), PNI (phrenic nerve injury), PV (pulmonary vein), RFA (radiofrequency ablation), RIPV (right inferior pulmonary vein), RSPV (right superior pulmonary vein), SVC (superior vena cava), VT (ventricular tachycardia)Keywords
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References
- Left atrial anatomy revisited.Circ Arrhythm Electrophysiol. 2012; 5: 220-228
- How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists.J Cardiovasc Electrophysiol. 2005; 16: 309-313
- The electrodiagnosis of neuropathy: basic principles and common pitfalls.Neurol Clin. 2007; 25: 1-28
- Diaphragm pacing by electrical stimulation of the phrenic nerve.Neurosurgery. 1985; 17: 974-984
- Three-dimensional reconstruction of the anatomic course of the right phrenic nerve in humans by pace mapping.Heart Rhythm. 2008; 5: 1120-1126
- Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography: implications for balloon-based procedures.Heart Rhythm. 2010; 7: 937-941
- Use of intracardiac echocardiography for early detection of phrenic nerve injury during cryoballoon pulmonary vein isolation.J Cardiovasc Electrophysiol. 2012; 23: 874-876
- Diaphragmatic electromyography during cryoballoon ablation: a novel concept in the prevention of phrenic nerve palsy.Heart Rhythm. 2011; 8: 885-891
- Novel electromyographic monitoring technique for prevention of right phrenic nerve palsy during cryoballoon ablation.Circ Arrhythm Electrophysiol. 2013; 6: 1109-1114
- Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury.Heart Rhythm. 2014; 11: 369-374
- Compound diaphragmatic action potentials can prevent phrenic nerve injury during cryoballoon ablation of atrial fibrillation.Heart Rhythm. 2014; 11: S374
- Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation.Heart Rhythm. 2013; 10: 646-652
- A novel method for preventing phrenic nerve injury during catheter ablation.Heart Rhythm. 2007; 4: 95-98
- 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
- Images in cardiovascular medicine: novel technique to prevent left phrenic nerve injury during epicardial catheter ablation.Circulation. 2008; 117: e471
Article info
Publication history
Published online: June 18, 2014
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© 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
