Key result
3D electroanatomic mapping of the phrenic nerve during radiofrequency pulmonary vein isolation required modification of the ablation trajectory to avoid nerve capture in 23% of cases.
Why the study?
Phrenic nerve injury is a rare but severe complication of radiofrequency pulmonary vein isolation, prompting characterization of its course to identify common capture areas and quantify necessary ablation trajectory modifications.
Does 3D electroanatomic pace-mapping of the phrenic nerve identify areas requiring ablation trajectory modification to prevent injury during radiofrequency pulmonary vein isolation?
Observational (n=137)
Does 3D electroanatomic pace-mapping of the phrenic nerve identify areas requiring ablation trajectory modification to prevent injury during radiofrequency pulmonary vein isolation?
High-output pace-mapping during radiofrequency pulmonary vein isolation frequently identifies the phrenic nerve in close proximity to standard ablation trajectories, requiring trajectory modification in nearly a quarter of patients to prevent injury.
Answers are grounded in this paper and cite their sources.
PN mapping identifies high-risk ablation sites during PVI; leaves open whether routine use reduces injury rates.
INTRODUCTION: Phrenic nerve (PN) injury is a rare but severe complication of radiofrequency (RF) pulmonary vein isolation (PVI). The objective of this study was to characterize the typical intracardiac course of the PN with a three-dimensional electroanatomic mapping system, to quantify the need for modification of the ablation trajectory to avoid delivering an ablation lesion on sites with PN capture, and to identify very circumscribed areas of common PNC on the routine ablation trajectory of a RF-PVI, allowing fast and effective PN screening for everyday usage. METHODS: We enrolled 137 consecutive patients (63 ± 9 years, 64% men) undergoing PVI. A detailed high output (20 mA) pace-mapping protocol was performed in the right (RA) and left atrium (LA) and adjacent vasculature. RESULTS: The right PN was most commonly captured in the superior vena cava at a lateral (50%) or posterolateral (23%) position before descending along the RA either straight (29%) or with a posterolateral bend (20%). In the LA, beginning deep within the right superior pulmonary vein (RSPV), the right PN is most frequently detectable anterolateral (31%), then descends to the lateral proximal RSPV (23%), and further towards the lateral antral region (15%) onto the medial LA wall (12%). To avoid delivering an ablation lesion on sites with PN capture, modification of ablation trajectory was necessary in 23% of cases, most commonly in the lateral RSPV antrum (81%). No PN injury occurred. CONCLUSION: PN mapping frequently reveals the close proximity of the PN to the ablation trajectory during PVI, particularly in the lateral RSPV antrum. Routine PN pacing should be considered during RF PVI procedures.
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Bohnen et al. (2022) conducted an observational in Patients undergoing radiofrequency pulmonary vein isolation (n=137). 3D electroanatomic mapping and high output pace-mapping of the phrenic nerve was evaluated on Modification of ablation trajectory to avoid phrenic nerve capture. 3D electroanatomic mapping of the phrenic nerve during radiofrequency pulmonary vein isolation required modification of the ablation trajectory to avoid nerve capture in 23% of cases.
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