Hands On| Volume 11, ISSUE 10, P1839-1844, October 2014

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Prevention of phrenic nerve injury during interventional electrophysiologic procedures

      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.


      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)


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