June 27, 2006
View Full PaperPhrenic Nerve Injury After Catheter Ablation: Should We Worry About This Complication?
Key Result
Phrenic nerve injury caused by catheter ablation functionally recovered in all 17 patients, with persistent cases resolving within a mean time of 8.3 ± 6.6 months.
Study Design
Type
Observational (n=17)
Structured PICO
Does phrenic nerve injury caused by catheter ablation functionally recover over time in affected patients?
P
Population
17 patients with phrenic nerve injury following various catheter ablation techniques, monitored for clinical recovery.
E
Exposure
Catheter ablation (radiofrequency, cryothermal, ultrasound, or laser) for various indications (pulmonary vein isolation, sinus node modification, epicardial ventricular tachycardia)
O
Outcome
Complete clinical recovery of phrenic nerve injury (defined as normalization of chest images and sniff test)safety
Phrenic nerve injury complicating catheter ablation appears to functionally recover completely over time, typically within several months for persistent cases.
Abstract
INTRODUCTION: Phrenic nerve injury (PNI) is a complication that can occur with catheter ablation. METHODS: Data from 17 patients with PNI following different catheter ablation techniques were reviewed. PNI was defined as decreased motility (transient) or paralysis (persistent) of the hemi-diaphragm on fluoroscopy or chest X-ray. Patient's recovery was monitored. Normalization of chest images and sniff test would be considered as complete clinical recovery. RESULTS: Out of the 17 PNI patients (16 right, 1 left), 13 (11 persistent, 2 transient) occurred after pulmonary veins isolation with or without superior vena cava ablation. Three patients had persistent PNI after sinus node modification and one other patient experienced PNI after epicardial ventricular tachycardia ablation. Ablation was performed with different energy source including radiofrequency (n = 13), cryothermal (n = 1), ultrasound (n = 2) and laser (n = 1). Patient's symptoms varied broadly from asymptomatic to dyspnea, and even to respiratory insufficiency that required temporary mechanical ventilation support. Two patients with transient PNI resolved immediately after the procedure and the other 15 persistent PNI patients resolved within a mean time of 8.3 +/- 6.6 months. CONCLUSIONS: PNI caused by catheter ablation appears to functionally recover over time regardless of the energy sources used for the procedure.