title: Phrenic paralysis during cardiac electronic device implantation: incidence, causes and clinical course.
abstract: OBJECTIVE
  Phrenic paralysis is a known complication of central venous catheterization, but it is not listed as a complication related to cardiac implantable electronic device (CIED) implants. The aim of this study is to describe the incidence, causes, clinical picture, and management of phrenic paralysis occurring in this scenario.
  
  
  RESULTS
  We retrospectively analysed data from our CIED implantation database and identified those patients who suffered phrenic paralysis during the implantation procedure. Four of 891 patients (subclavian puncture in 626) developed phrenic paralysis during pacemaker or defibrillator implant procedures. Severe respiratory failure needing ventilatory support occurred in two, being the phrenic paralysis transient in all of the cases.
  
  
  CONCLUSIONS
  Transient phrenic paralysis may occur during CIED implantation probably related to the infiltration of local anaesthesia in the subclavian area. Mechanism, prevention, and management are discussed.
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain mlopezgil@secardiologia.es.
authors.forename: María
authors.initials: M
authors.lastname: López-Gil
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Fontenla
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain.
authors.forename: Justo
authors.initials: J
authors.lastname: Juliá
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Parra
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D059348:Peripheral Nerve Injuries / Q000209:etiology*; D010791:Phrenic Nerve / Q000293:injuries*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D013902:Radiography, Thoracic; D012133:Respiratory Paralysis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome
keywords: Complication; Defibrillator; Pacemaker; Phrenic paralysis