3 years ago

Phrenic Nerve Limitation During Epicardial Catheter Ablation of Ventricular Tachycardia

Kenji Okubo, Nicola Trevisi, Luca Foppoli, Caterina Bisceglia, Francesca Baratto, Lorenzo Gigli, Giuseppe D’angelo, Andrea Radinovic, Manuela Cireddu, Gabriele Paglino, Patrizio Mazzone, Paolo Della Bella

Publication date: Available online 26 September 2018

Source: JACC: Clinical Electrophysiology

Author(s): Kenji Okubo, Nicola Trevisi, Luca Foppoli, Caterina Bisceglia, Francesca Baratto, Lorenzo Gigli, Giuseppe D’Angelo, Andrea Radinovic, Manuela Cireddu, Gabriele Paglino, Patrizio Mazzone, Paolo Della Bella

Abstract
Objectives

This study sought to investigate the incidence of phrenic nerve (PN) limitation and the utility of displacing the PN with a balloon.

Background

The PN can limit the epicardial ablation of ventricular tachycardia (VT).

Methods

From 2010 to 2017, 363 patients undergoing VT epicardial ablation at a single center were studied. Before the ablation, we used high output (20-mA) pacing maneuvers to verify the course of the PN. When we observed its capture, we used 1 of 3 different approaches to protect it: 1) non-balloon strategy (nerve-sparing ablation), 2) PN displacement with a small balloon (6 mm × 20 mm), or 3) PN displacement with a large balloon (20 mm × 45 mm).

Results

PN capture occurred in 25 patients (7%) at the target ablation site. The most common cause was myocarditis (12 patients [48%]), and the incidence of the PN limitation was significantly higher in myocarditis than in other causes (19% vs. 4%, respectively; p = 0.0002). PN displacement was attempted in 7 patients by using large balloons and in 6 patients with small balloons, resulting in successful PN displacements and complete late potential (LP) abolition in 6 patients (86%) and 3 patients (50%), respectively. Among the 12 patients in whom the non-balloon strategy was used, only 1 patient (8%) achieved LP abolition (compared with the large balloon group; p = 0.002), whereas 3 patients experienced PN paralysis.

Conclusions

The PN limited the epicardial ablation in 7% of patients. Because nerve-sparing ablations often resulted in PN injuries, a possible solution could be to displace the PN with a large balloon, leading to a safer procedure and completion of LP abolition.

Graphical abstract

Graphical abstract for this article

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.