Phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia:Four case reports

Antonio Taormina; Giuseppe Sgarito; Sergio Conti; Umberto Giordano; Vito Bonomo

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Phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia:Four case reports

Phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia:Four case reports

作者：

Antonio Taormina Giuseppe Sgarito Sergio Conti Umberto Giordano Vito Bonomo

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CATHETER

ablation

EPICARDIAL

access

MYOCARDITIS

Nonischemic

CARDIOMYOPATHY

Ventricular

TACHYCARDIA

Phrenic

nerve

Case

series

摘要：

BACKGROUND Phrenic nerve(PN)injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia(VT).High-output pacing is a widely used maneuver to establish a relationship between the PN and the ablation catheter tip.An absence of PN capture is usually considered an indication that it is safe to ablate,and that successful ablation may be performed at adjacent sites.However,PN capture may impact the procedural outcome.Only a few cases have been reported in the literature that avoid PN injury by using different techniques.CASE SUMMARY Three patients with a previous history of myocarditis and one patient with ischemic cardiomyopathy underwent epicardial ablation for drug-refractory VT.Before the procedure,transthoracic echocardiogram,coronary angiogram,and cardiac magnetic resonance imaging were performed on all patients.Under general anesthesia,endo/epicardial three-dimensional anatomical and substrate maps of the left ventricle were accomplished.Before radiofrequency delivery,the course of the PN was identified by provoking diaphragmatic stimulation with high-output pacing from the distal electrode of the ablation catheter.In every case,a scar region with late potentials was mapped along the PN course.After obtaining another epicardial access,a second introducer sheath was placed,and a vascular balloon catheter was inserted into the epicardial space and inflated with saline solution to separate the PN from the epicardium.Once the absence of PN capture had been proven,radiofrequency was applied to aim for complete late potential elimination and avoid VT induction.CONCLUSION PN injury can occur as one of the complications following epicardial VT ablation procedures,and may prevent successful ablation of these arrhythmias.PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible,avoid procedure-related morbidity,and improve ablation success when performed in selected centers and by experienced operators.

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世界心脏病学杂志：英文版（电子版）2021 世界心脏病学杂志：英文版（电子版）2020 世界心脏病学杂志：英文版（电子版）2019

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篇名	Phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia:Four case reports
来源期刊	世界心脏病学杂志:英文版(电子版)	学科	医学
关键词	CATHETER ablation EPICARDIAL access MYOCARDITIS Nonischemic CARDIOMYOPATHY Ventricular TACHYCARDIA Phrenic nerve Case series
年，卷（期）	2020,（1）	所属期刊栏目
研究方向		页码范围	55-66
页数	12页	分类号	R31
字数		语种
DOI