title: Three-dimensional imaging and mapping of the right and left phrenic nerves: relevance to interventional cardiovascular therapy.
abstract: OBJECTIVE
  Phrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping.
  
  
  RESULTS
  Forty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 ± 5.8 mm.
  
  
  CONCLUSIONS
  The 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy.
authors: Cardiology Division, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku city, Tokyo, Japan. sound-vision@a5.keio.jp
authors: Kotaro
authors: K
authors: Fukumoto
authors: Seiji
authors: S
authors: Takatsuki
authors: Masahiro
authors: M
authors: Jinzaki
authors: Minoru
authors: M
authors: Yamada
authors: Kojiro
authors: K
authors: Tanimoto
authors: Nobuhiro
authors: N
authors: Nishiyama
authors: Yoshiyasu
authors: Y
authors: Aizawa
authors: Yoko
authors: Y
authors: Hagiwara
authors: Yukiko
authors: Y
authors: Fukuda
authors: Takehiro
authors: T
authors: Kimura
authors: Shunichiro
authors: S
authors: Miyoshi
authors: Sachio
authors: S
authors: Kuribayashi
authors: Keiichi
authors: K
authors: Fukuda
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D010791:Phrenic Nerve / Q000000981:diagnostic imaging* / Q000293:injuries; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Computed tomography; Open chest surgery; Phrenic nerve