Key result
Pericardial balloon displacement protects the phrenic nerve during successful periphrenic right atrial tachycardia ablation.
Why the study?
Does balloon inflation in the pericardial space protect the right phrenic nerve during catheter ablation of posterolateral right atrial tachycardias?
Case Report (n=1)
Does balloon inflation in the pericardial space protect the right phrenic nerve during catheter ablation of posterolateral right atrial tachycardias?
Balloon inflation in the pericardial space using the anterior pericardium for leverage is a viable technique to protect the right phrenic nerve during endocardial ablation of posterolateral right atrial tachycardias.
Answers are grounded in this paper and cite their sources.
May permit safe periphrenic right atrial tachycardia ablation; leaves open generalizability beyond this single case.
KEY TEACHING POINTS•Ablation of the atrial tachycardias arising from the posterolateral right atrium can be hazardous because of the proximity of the right phrenic nerve that may be injured. Proximity of the ablation catheter to the nerve may be identified by capture during pacing.•Balloon inflation in the pericardial space has been described to protect the left phrenic nerve in the setting of epicardial ventricular tachycardia ablation. Techniques to protect the right phrenic nerve during endocardial atrial ablation procedures have not been well described.•The maneuver of balloon inflation in the pericardial space to separate the right phrenic nerve from the arrhythmogenic atrial myocardium is more complex because of anatomical challenges unique to this location.•The right phrenic nerve can course adjacent to a pericardial reflection, and it can be difficult to position a balloon adjacent to this reflection. We used the anterior pericardium “to push against” and thus force the posterolateral pericardium and the embedded phrenic nerve away from the ablation catheter. Open table in a new tab
No takes yet. Share an insight, caveat, or question.
Stark et al. (2017) conducted a case report in Recurrent atrial tachycardia (n=1). Catheter ablation with pericardial balloon displacement using an extra-stiff wire was evaluated on Successful arrhythmia termination without phrenic nerve injury. Deploying a pericardial balloon and using an extra-stiff wire against the anterior pericardium to mechanically displace the right phrenic nerve allowed safe and successful catheter ablation of a periphrenic right atrial tachycardia.
Synapse has enriched 10 related papers. Consider them for comparative context: