Phrenic nerve damage during right superior pulmonary vein isolation using a high-intensity focused ultrasound balloon occurred at the antero-inferior ostium despite using an oversized balloon.
Case Report (n=1)
This case report highlights the risk and precise anatomical location of phrenic nerve injury during balloon-based high-intensity focused ultrasound ablation for atrial fibrillation.
Injury of the phrenic nerve during pulmonary vein isolation for the treatment of atrial fibrillation is a well-recognized complication, especially when performing ostial ablations or using balloon-based technologies. This report describes the exact anatomical location of phrenic nerve injury during an attempt of right superior pulmonary vein isolation using a balloon that delivered high intensity focused ultrasound. Electroanatomical three-dimensional CARTO (Biosense Webster, Diamond Bar, CA, USA) mapping of the superior caval vein, the right and left atrium, as well as the right superior pulmonary vein was performed in conjunction with meticulous phrenic nerve pacing maneuvers before and after ablation and showed that the nerve was damaged at the level of the antero-inferior ostium of the right superior pulmonary vein. Diaphragmatic denervation occurred despite using an oversized balloon fluoroscopically placed at the atrial side of the pulmonary vein ostium.
Antz et al. (Mon,) conducted a case report in Atrial fibrillation (n=1). High intensity focused ultrasound balloon ablation was evaluated on Anatomical location of phrenic nerve injury. Phrenic nerve damage during right superior pulmonary vein isolation using a high-intensity focused ultrasound balloon occurred at the antero-inferior ostium despite using an oversized balloon.