Key result
Supine dynamic chest radiography unmasks post-cryoballoon phrenic nerve palsy missed in the upright position.
Why the study?
Phrenic nerve palsy caused by cryoballoon ablation for atrial fibrillation may be underdiagnosed using upright position chest radiography.
Does supine position dynamic chest radiography improve detection of phrenic nerve palsy compared to upright position in patients post-cryoballoon ablation?
Case Report (n=1)
Does supine position dynamic chest radiography improve detection of phrenic nerve palsy compared to upright position in patients post-cryoballoon ablation?
Supine position dynamic chest radiography may be necessary to detect phrenic nerve palsy after cryoballoon ablation, as upright radiography can miss the diagnosis due to gravity and abdominal muscle contraction.
May support supine dynamic radiography to avoid missing phrenic nerve palsy post-cryoballoon ablation; hypothesis-generating and requires prospective validation before practice change.
A 77-year-old man with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using a 28 mm 4th-generation cryoballoon. Despite the immediate termination of cryoablation of the right superior PV upon weakened diaphragmatic motion detection, right phrenic nerve palsy (PNP) was observed fluoroscopically. PNP was followed using dynamic chest radiography (DCR) in the upright and supine positions using a dynamic flat-panel detector imaging system (Konica Minolta Inc., Tokyo, Japan). PNP was only detectable with supine position (Panels 1C–E, Supplementary material online, Movie) but not in upright position (Panels 1A and B, Supplementary material online, Movie), possibly due to the passive effect of gravity and active tonic contraction of abdominal muscles. Full recovery was achieved in 7 months (Panel 1F). Bilateral diaphragmatic synchronization was felt to be a better marker of PNP recovery as the diaphragmatic excursion distance depends on the depth...
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Katsume et al. (2021) conducted a case report in Paroxysmal atrial fibrillation and phrenic nerve palsy (n=1). Supine position dynamic chest radiography vs. Upright position dynamic chest radiography was evaluated on Detection of phrenic nerve palsy. Supine position dynamic chest radiography successfully detected right phrenic nerve palsy following cryoballoon ablation, which was undetectable in the upright position.
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