- Remote monitoring (RM) of cardiac implantable devices is rapidly becoming the standard of care for implantable cardiac device follow-up.
- 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.
- Since its introduction, percutaneous epicardial access is increasingly being performed to facilitate catheter ablation of ventricular tachycardias (VTs) with epicardial circuits, difficult cases of idiopathic VTs, focal atrial tachycardia, and accessory pathways that cannot be successfully targeted endocardially.1 A thorough understanding of the clinical anatomy and potential complications is vital in order to perform a safe procedure.2 In this article, we present the clinical anatomy related to epicardial access, the technique of performing a subxiphoid epicardial puncture, and various measures to prevent complications.