Key result
In 30 cadavers, the left phrenic nerve coursed along the lateral surface of the left atrial appendage in 66.6% of cases and crossed cardiac veins suitable for CRT in 6.6% of cases.
Observational (n=30)
Detailed anatomical knowledge of the spatial relationship of phrenic nerves with cardiac structures highlights critical locations where the nerve is susceptible to injury during catheter ablation or stimulation during left ventricular pacing.
May inform phrenic nerve avoidance in AF ablation and CRT; leaves open in vivo validation before practice change.
BACKGROUND: Pulmonary vein (PV) isolation with catheter ablation in treating atrial fibrillation carries the risk of injury to phrenic nerve (PN). Left PN (LPN) stimulation continues to be one of the common complications of transvenous left ventricular lead placement during cardiac resynchronization therapy (CRT). METHODS AND RESULTS: In 30 formalin-fixed cadavers, spatial relationship of PNs with PV ostia, left atrial appendage (LAA), and cardiac veins was observed. Segmental location of LPN and cardiac vein crossover was also noted. Right and left PNs coursed abutting the ostium of right superior and left superior PVs in five (16.6%) and one (3.33%) cases, respectively. LPN coursed along the lateral surface of LAA in 20 (66.66%) cases and behind LAA in one (3.33%) case. Out of 18 (60%) cases having two cardiac veins draining free wall of left ventricle (LV) and suitable for CRT lead placement, both cardiac veins were crossed by LPN in two (6.66%) cases. LPN-cardiac vein crossover was located in midlateral segment in 10 (33.3%) cases; mid posterolateral segment in five (16.7%) cases; apical lateral segment and apical posterolateral segment in three (10.0%) cases each. CONCLUSION: PN is highly susceptible to either injury during catheter ablation or stimulation with LV pacing in certain critical locations. Detailed knowledge of spatial relationship of PNs with cardiac structures could help minimize inadvertent complications during these transcatheter electrophysiological procedures.
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Sahni et al. (2014) reported an observational. Anatomical location of phrenic nerves was evaluated on Spatial relationship of phrenic nerves with pulmonary vein ostia, left atrial appendage, and cardiac veins. In 30 cadavers, the left phrenic nerve coursed along the lateral surface of the left atrial appendage in 66.6% of cases and crossed cardiac veins suitable for CRT in 6.6% of cases.
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