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Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation

Phrenic Nerve Injury (PNI) has been well studied by cardiac surgeons. More recently it has been recognized as a potential complication of catheter ablation with a prevalence of 0.11 to 0.48 % after atrial fibrillation (AF) ablation. This review will focus on PNI after AF ablation Anatomical studies...

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Autores principales: Sacher, Frederic, Jais, Pierre, Stephenson, Kent, O'Neill, Mark D, Hocini, Meleze, Clementy, Jacques, Stevenson, William G, Haissaguerre, Michel
Formato: Texto
Lenguaje:English
Publicado: Indian Heart Rhythm Society 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764817/
https://www.ncbi.nlm.nih.gov/pubmed/17235367
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author Sacher, Frederic
Jais, Pierre
Stephenson, Kent
O'Neill, Mark D
Hocini, Meleze
Clementy, Jacques
Stevenson, William G
Haissaguerre, Michel
author_facet Sacher, Frederic
Jais, Pierre
Stephenson, Kent
O'Neill, Mark D
Hocini, Meleze
Clementy, Jacques
Stevenson, William G
Haissaguerre, Michel
author_sort Sacher, Frederic
collection PubMed
description Phrenic Nerve Injury (PNI) has been well studied by cardiac surgeons. More recently it has been recognized as a potential complication of catheter ablation with a prevalence of 0.11 to 0.48 % after atrial fibrillation (AF) ablation. This review will focus on PNI after AF ablation Anatomical studies have shown a close relationship between the right phrenic nerve and it's proximity to the superior vena cava (SVC), and the antero-inferior part of the right superior pulmonary vein (RSPV). In addition, the proximity of the left phrenic nerve to the left atrial appendage has been well established. Independent of the type of ablation catheter (4mm, 8 mm, irrigated tip, balloon) or energy source used (radiofrequency (RF), ultrasound, cryothermia, and laser); the risk of PNI exists during ablation at the critical areas listed above. Although up to thirty-one percent of patients with PNI after AF ablation remain asymptomatic, dyspnea remain the cardinal symptom and is present in all symptomatic patients. Despite the theoretical risk for significant adverse effect on functional status and quality of life, short-term outcomes from published studies appear favorable with 81% of patients with PNI having a complete recovery after 7 ± 7 months. CONCLUSION: Existing studies have described PNI as an uncommon but avoidable complication in patients undergoing pulmonary vein isolation for AF. Prior to ablation at the SVC, antero-inferior RSPV ostium or the left atrial appendage, pacing should be performed before energy delivery. If phrenic nerve capture is documented, energy delivery should be avoided at this site. Electrophysiologist's vigilance as well as pacing prior to ablation at high risk sites in close proximity to the phrenic nerve are the currently available tools to avoid the complication of PNI.
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spelling pubmed-17648172007-01-17 Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation Sacher, Frederic Jais, Pierre Stephenson, Kent O'Neill, Mark D Hocini, Meleze Clementy, Jacques Stevenson, William G Haissaguerre, Michel Indian Pacing Electrophysiol J Editorial Phrenic Nerve Injury (PNI) has been well studied by cardiac surgeons. More recently it has been recognized as a potential complication of catheter ablation with a prevalence of 0.11 to 0.48 % after atrial fibrillation (AF) ablation. This review will focus on PNI after AF ablation Anatomical studies have shown a close relationship between the right phrenic nerve and it's proximity to the superior vena cava (SVC), and the antero-inferior part of the right superior pulmonary vein (RSPV). In addition, the proximity of the left phrenic nerve to the left atrial appendage has been well established. Independent of the type of ablation catheter (4mm, 8 mm, irrigated tip, balloon) or energy source used (radiofrequency (RF), ultrasound, cryothermia, and laser); the risk of PNI exists during ablation at the critical areas listed above. Although up to thirty-one percent of patients with PNI after AF ablation remain asymptomatic, dyspnea remain the cardinal symptom and is present in all symptomatic patients. Despite the theoretical risk for significant adverse effect on functional status and quality of life, short-term outcomes from published studies appear favorable with 81% of patients with PNI having a complete recovery after 7 ± 7 months. CONCLUSION: Existing studies have described PNI as an uncommon but avoidable complication in patients undergoing pulmonary vein isolation for AF. Prior to ablation at the SVC, antero-inferior RSPV ostium or the left atrial appendage, pacing should be performed before energy delivery. If phrenic nerve capture is documented, energy delivery should be avoided at this site. Electrophysiologist's vigilance as well as pacing prior to ablation at high risk sites in close proximity to the phrenic nerve are the currently available tools to avoid the complication of PNI. Indian Heart Rhythm Society 2007-01-01 /pmc/articles/PMC1764817/ /pubmed/17235367 Text en Copyright: © 2007 Sacher et al. http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Editorial
Sacher, Frederic
Jais, Pierre
Stephenson, Kent
O'Neill, Mark D
Hocini, Meleze
Clementy, Jacques
Stevenson, William G
Haissaguerre, Michel
Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title_full Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title_fullStr Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title_full_unstemmed Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title_short Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation
title_sort phrenic nerve injury after catheter ablation of atrial fibrillation
topic Editorial
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764817/
https://www.ncbi.nlm.nih.gov/pubmed/17235367
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