title: Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy.
abstract: The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left-sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion-fixed human heart-lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three-dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°-111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens.
authors: Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.|Department of Surgery, University of Minnesota, Minneapolis, Minnesota.|Medtronic Inc., Mounds View, Minnesota.
authors: Julianne H
authors: JH
authors: Spencer
authors: Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.|Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors: Ryan P
authors: RP
authors: Goff
authors: Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors: Paul A
authors: PA
authors: Iaizzo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D003287:Contrast Media; D003331:Coronary Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D010477:Perfusion / Q000379:methods; D010791:Phrenic Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D016707:Tissue Fixation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: anatomy; cardiac resynchronization; coronary venous system; phrenic nerve