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A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report

BACKGROUND: Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this procedure. Therefore, in cases where the right atrium (RA)-SVC conduction site is near th...

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Autores principales: Arai, Tomoyuki, Hojo, Rintaro, Kitamura, Takeshi, Fukamizu, Seiji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780490/
https://www.ncbi.nlm.nih.gov/pubmed/33426459
http://dx.doi.org/10.1093/ehjcr/ytaa312
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author Arai, Tomoyuki
Hojo, Rintaro
Kitamura, Takeshi
Fukamizu, Seiji
author_facet Arai, Tomoyuki
Hojo, Rintaro
Kitamura, Takeshi
Fukamizu, Seiji
author_sort Arai, Tomoyuki
collection PubMed
description BACKGROUND: Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this procedure. Therefore, in cases where the right atrium (RA)-SVC conduction site is near the PN, tremendous care is required to prevent PN injury. CASE SUMMARY: Repeated SVC isolation was performed due to the recurrence of SVC-triggered AF. The RA-SVC activation map revealed that the partial conduction block line was detected, and the propagation broke through the gap at the course of the PN site from the RA to the SVC. Since the course of the PN identified at high-output pacing was wide, the SVC was isolated by making longitudinal lines on both sides of the PN in a cranial direction, except for where low-output pacing captured, confirming compound muscle action potential to detect PN injury. Eventually, the SVC was successfully isolated without PN injury, and the sinus rhythm was maintained without antiarrhythmic drugs during a 14-month follow-up period. CONCLUSION: Superior vena cava isolation was difficult depending on the course of the PN, and some methods to avoid PN injury were reported. However, this method can facilitate safe and effective SVC isolation with the conventional system, including the cases with AF foci located on the course of the PN.
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spelling pubmed-77804902021-01-07 A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report Arai, Tomoyuki Hojo, Rintaro Kitamura, Takeshi Fukamizu, Seiji Eur Heart J Case Rep Case Reports BACKGROUND: Superior vena cava (SVC) isolation has improved the outcomes of paroxysmal atrial fibrillation (AF) originating from the SVC. However, right phrenic nerve (PN) injury is a major complication of this procedure. Therefore, in cases where the right atrium (RA)-SVC conduction site is near the PN, tremendous care is required to prevent PN injury. CASE SUMMARY: Repeated SVC isolation was performed due to the recurrence of SVC-triggered AF. The RA-SVC activation map revealed that the partial conduction block line was detected, and the propagation broke through the gap at the course of the PN site from the RA to the SVC. Since the course of the PN identified at high-output pacing was wide, the SVC was isolated by making longitudinal lines on both sides of the PN in a cranial direction, except for where low-output pacing captured, confirming compound muscle action potential to detect PN injury. Eventually, the SVC was successfully isolated without PN injury, and the sinus rhythm was maintained without antiarrhythmic drugs during a 14-month follow-up period. CONCLUSION: Superior vena cava isolation was difficult depending on the course of the PN, and some methods to avoid PN injury were reported. However, this method can facilitate safe and effective SVC isolation with the conventional system, including the cases with AF foci located on the course of the PN. Oxford University Press 2020-09-09 /pmc/articles/PMC7780490/ /pubmed/33426459 http://dx.doi.org/10.1093/ehjcr/ytaa312 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Arai, Tomoyuki
Hojo, Rintaro
Kitamura, Takeshi
Fukamizu, Seiji
A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title_full A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title_fullStr A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title_full_unstemmed A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title_short A new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
title_sort new method of superior vena cava isolation without phrenic nerve injury by longitudinal ablation parallel to the phrenic nerve: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780490/
https://www.ncbi.nlm.nih.gov/pubmed/33426459
http://dx.doi.org/10.1093/ehjcr/ytaa312
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