PO-04-060 FOUND WITH SOUND: INTRACARDIAC ECHOCARDIOGRAPHY CORRELATED WITH MEDIUM-OUTPUT PACING TO AVOID PHRENIC NERVE INJURY WITH RIGHT ATRIAL ABLATION

Catheter ablation within the right atrium can be limited by proximity to phrenic nerve and potential for hemi diaphragmatic paralysis. High output pacing is frequently employed map position relative endocardium, particularly in relation superior vena cava pulmonary vein. The use of intracardiac echocardiography (ICE) correlation with lower rigorously course along has not been previously described. We describe a case incessant atrial tachycardia successfully mapped ablated close using combination ICE imaging medium-output nerve. n/a An 18-year-old man was referred repeat following unsuccessful attempt at an outside institution. Prior transient palsy cryoablation mid crista terminalis. Epicardial access deflect anticipated. Atrial endocardially prior obtaining epicardial access. catheter advanced SVC used identify integrated into CARTO navigational system (Biosense Webster). Pacing performed 10 mA further refine atrium. Regions anatomic loss pace-capture correlated sites physiologic effusion, where pericardial fluid concentrated separation from visceral epicardium noted. After mapping nerve, endocardial absence injury without need Phrenic may prevented rigorous ultrasound pacing.