Protecting the right phrenic nerve during catheter ablation: Techniques and anatomical considerations
نویسندگان
چکیده
Introduction Phrenic nerve injury is a recognized complication of catheter ablation procedures for atrial and ventricular arrhythmias. The posterolateral right atrium (RA) is a common site of origin for atrial tachycardias (AT), but ablation in this region can be hazardous because of the proximity of the right phrenic nerve (RPN). Proximity to the nerve may be identified by capture during pacing to avoid injury during energy application. Balloon inflation in the epicardial space and the infusion of saline and of air into the pericardial space have been described to protect the left phrenic nerve in the setting of epicardial ventricular tachycardia ablation. Techniques to protect the RPN during endocardial atrial ablation procedures have been described but not as comprehensively. We discuss a case to highlight the difficulties of catheter ablation of “periphrenic” right AT and to describe epicardial catheter techniques for RPN protection to permit safe endocardial ablation from the posterolateral RA.
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