Key result
Crista terminalis cryoablation with diaphragmatic pacing terminates atrial tachycardia and prevents phrenic nerve injury.
Case Report (n=1)
Continuous phrenic nerve pacing from the subclavian vein can be a safe and effective technique to prevent phrenic nerve injury during focal cryoablation of right-sided non-pulmonary vein triggers.
Continuous diaphragmatic pacing may protect the phrenic nerve during right atrial cryoablation; leaves open generalizability beyond this single case.
Almost 90% of triggers for atrial fibrillation (AF) are believed to originate from the pulmonary veins,1 and pulmonary vein isolation is the mainstay of therapy for patients with paroxysmal AF.2 Patients who demonstrate recurrent AF despite pulmonary vein isolation highlight the challenge and need of identifying non–pulmonary vein triggers. Reproducibility and inherent risk of the location of these foci may limit the success.
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Misher et al. (2017) conducted a case report in Recurrent symptomatic paroxysmal atrial fibrillation (n=1). Cryoablation with continuous diaphragmatic phrenic nerve pacing was evaluated on Freedom from atrial fibrillation and atrial tachycardia. Focal cryoablation of a non-pulmonary vein trigger at the crista terminalis, combined with continuous diaphragmatic pacing, successfully terminated atrial tachycardia and maintained freedom from arrhythmias at 9 months without phrenic nerve injury.
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