Key result
Comprehensive phrenic nerve mapping and parallel ablation may avoid right phrenic nerve damage, which otherwise limits successful superior vena cava isolation in up to 18% of cases.
Why the study?
Right phrenic nerve damage is the most common complication of SVC isolation for AF, and avoiding it limits successful isolation in up to 18% of cases.
Does comprehensive phrenic nerve mapping and parallel ablation prevent right phrenic nerve damage during superior vena cava isolation in patients with atrial fibrillation?
Does comprehensive phrenic nerve mapping and parallel ablation prevent right phrenic nerve damage during superior vena cava isolation in patients with atrial fibrillation?
A novel ablation strategy involving comprehensive mapping and parallel ablation may help avoid right phrenic nerve injury during superior vena cava isolation for atrial fibrillation.
Should not change practice; leaves open whether mapping-guided ablation improves SVC isolation success.
Key Teaching Points•The superior vena cava (SVC) can serve as a substrate for initiation and maintenance of atrial fibrillation (AF), and isolation of the SVC can prevent AF recurrence in these patients.•Damage to the right phrenic nerve is the most common complication, and its avoidance limits successful isolation in up to 18% of cases.•Damage to the right phrenic nerve may be avoided by comprehensive phrenic nerve mapping and ablation parallel to the phrenic nerve until the point at which diaphragmatic capture is no longer present in the right atrium and then connecting this line to a circumferential ablation line within the SVC. •The superior vena cava (SVC) can serve as a substrate for initiation and maintenance of atrial fibrillation (AF), and isolation of the SVC can prevent AF recurrence in these patients.•Damage to the right phrenic nerve is the most common complication, and its avoidance limits successful isolation in up to 18% of cases.•Damage to the right phrenic nerve may be avoided by comprehensive phrenic nerve mapping and ablation parallel to the phrenic nerve until the point at which diaphragmatic capture is no longer present in the right atrium and then connecting this line to a circumferential ablation line within the SVC.
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Wann et al. (2019) studied Atrial fibrillation. Superior vena cava electrical isolation with comprehensive phrenic nerve mapping and parallel ablation was evaluated. Comprehensive phrenic nerve mapping and parallel ablation may avoid right phrenic nerve damage, which otherwise limits successful superior vena cava isolation in up to 18% of cases.
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