Phrenic nerve injury after catheter ablation: should we worry about this complication?
BACKGROUND
Phrenic nerve injury (PNI) is a complication that can occur with catheter ablation.


METHODS
Data from 17 patients with PNI following different catheter ablation techniques were reviewed. PNI was defined as decreased motility (transient) or paralysis (persistent) of the hemi-diaphragm on fluoroscopy or chest X-ray. Patient's recovery was monitored. Normalization of chest images and sniff test would be considered as complete clinical recovery.


RESULTS
Out of the 17 PNI patients (16 right, 1 left), 13 (11 persistent, 2 transient) occurred after pulmonary veins isolation with or without superior vena cava ablation. Three patients had persistent PNI after sinus node modification and one other patient experienced PNI after epicardial ventricular tachycardia ablation. Ablation was performed with different energy source including radiofrequency (n = 13), cryothermal (n = 1), ultrasound (n = 2) and laser (n = 1). Patient's symptoms varied broadly from asymptomatic to dyspnea, and even to respiratory insufficiency that required temporary mechanical ventilation support. Two patients with transient PNI resolved immediately after the procedure and the other 15 persistent PNI patients resolved within a mean time of 8.3 +/- 6.6 months.


CONCLUSIONS
PNI caused by catheter ablation appears to functionally recover over time regardless of the energy sources used for the procedure.
Bai
Rong
R
Department of Cardiology, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Patel
Dimpi
D
Di Biase
Luigi
L
Fahmy
Tamer S
TS
Kozeluhova
Marketa
M
Prasad
Subramanya
S
Schweikert
Robert
R
Cummings
Jennifer
J
Saliba
Walid
W
Andrews-Williams
Michelle
M
Themistoclakis
Sakis
S
Bonso
Aldo
A
Rossillo
Antonio
A
Raviele
Antonio
A
Schmitt
Claus
C
Karch
Martin
M
Uriarte
Jorge A Salerno
JA
Tchou
Patrick
P
Arruda
Mauricio
M
Natale
Andrea
A
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010791:Phrenic Nerve / Q000293:injuries*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies