PO-01-081 EPICARDIAL PHRENIC NERVE DEFLECTION DURING SINUS NODE MODIFICATION

Endocardial catheter ablation for sinus node modification may be difficult due to right phrenic nerve location and risk of injury. Various strategies displace the from target sites have been described previously, including saline infusion balloon insufflation, all within epicardial space. To describe a strategy avoid injury during endocardial using steerable catheter. N/A A 33-year-old female with history Behcet’s disease AF ablations but otherwise without structural heart developed symptomatic inappropriate tachycardia (IST) recorded on her loop recorder. Her IST was refractory multiple drugs flecainide, sotalol, dofetilide, ivabradine. She had previously undergone modification, which limited proximity near intended target. presented repeat planned access modification. The patient EP lab in rhythm rates 60s. were obtained under general anesthesia. advanced into superior vena cava atrium, activation map isoproterenol capture annotated (Figure A). Using sheath non-irrigated 4mm via access, deflected away node. between catheters confirmed fluoroscopy B). checked before after each lesion. total 11 lesions at 30W contact >10 grams impedance drop ohms delivered 333 seconds C). Following ablation, resting decreased 50s. Isoproterenol challenge revealed blunted response rate. remained intact appropriate diaphragm stimulation. resumed sotalol discharged. challenging nerve. Epicardial deflection required.