Phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia: Four case reports.
Case series
Catheter ablation
Epicardial access
Myocarditis
Nonischemic cardiomyopathy
Phrenic nerve
Ventricular tachycardia
Journal
World journal of cardiology
ISSN: 1949-8462
Titre abrégé: World J Cardiol
Pays: United States
ID NLM: 101537090
Informations de publication
Date de publication:
26 Jan 2020
26 Jan 2020
Historique:
received:
13
05
2019
revised:
28
08
2019
accepted:
14
10
2019
entrez:
28
1
2020
pubmed:
28
1
2020
medline:
28
1
2020
Statut:
ppublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Identifiants
pubmed: 31984128
doi: 10.4330/wjc.v12.i1.55
pmc: PMC6952720
doi:
Types de publication
Case Reports
Langues
eng
Pagination
55-66Informations de copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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