title: Low vulnerability of the right phrenic nerve to electroporation ablation.
abstract: BACKGROUND
  Circular electroporation ablation is a novel ablation modality for electrical pulmonary vein isolation. With a single 200-J application, deep circular myocardial lesions can be created. However, the acute and chronic effects of this energy source on phrenic nerve (PN) function are unknown.
  
  
  OBJECTIVE
  The purpose of this study was to analyze nerve vulnerability to electroporation ablation in a porcine model.
  
  
  METHODS
  In 20 animals (60-75 kg), the course of the right PN was pace-mapped inside the superior caval vein (SCV). Thereafter, a single 200-J circular electroporation ablation was performed via a multipolar circular catheter in firm contact with the inner SCV wall.
  
  
  RESULTS
  In 19 of 20 animals, the PN could be captured along an estimated 6-8 cm trajectory above the right atrial contour. Directly after the application, the PN could be captured above the ablation level in 17 of 19 animals and after maximally 30 minutes in all animals. Fifteen animals were restudied after 3-13 weeks, and PN functionality was unaffected in all. Histological analysis in 5 animals in which the application had been delivered in the muscular sleeve just above the right atrium showed a transmural circular lesion. However, no lesion was found in the other animals in which the application had been delivered in the fibrous section more cranial in the SCV.
  
  
  CONCLUSIONS
  Electroporation ablation at an energy level that may create deep myocardial lesions may spare the targeted right PN. These animal data suggest that electroporation may be a safe ablation modality near the right PN.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Vincent J H M
authors.initials: VJ
authors.lastname: van Driel
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany. Electronic address: kars_neven@hotmail.com.
authors.forename: Kars
authors.initials: K
authors.lastname: Neven
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; St. Jude Medical, Veenendaal, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Wessel
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Aryan
authors.initials: A
authors.lastname: Vink
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Pieter A F M
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Wittkampf
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018274:Electroporation / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006335:Heart Injuries / Q000150:complications* / Q000209:etiology; D010791:Phrenic Nerve / Q000293:injuries* / Q000502:physiology; D013552:Swine
keywords: Ablation; Complication; Irreversible electroporation; Nervous system; Phrenic nerve