title: Imaging of Pericardiophrenic Bundles Using Multislice Spiral Computed Tomography for Phrenic Nerve Anatomy.
abstract: Phrenic nerve injury and diaphragmatic stimulation are common complications following arrhythmia ablation and pacing therapies. Preoperative comprehension of phrenic nerve anatomy via non-invasive CT imaging may help to minimize the electrophysiological procedure-related complications.
  
  
  
  Coronary CT angiography data of 121 consecutive patients were collected. Imaging of left and right pericardiophrenic bundles was performed with volume rendering and multi-planar reformation techniques. The shortest spatial distances between phrenic nerves and key electrophysiology-related structures were determined. The frequencies of the shortest distances ≤5 mm, >5 mm and direct contact between phrenic nerves and adjacent structures were calculated.
  
  
  
  Left and right pericardiophrenic bundles were identified in 86.8% and 51.2% of the patients, respectively. The right phrenic nerve was <5 mm from right superior and inferior pulmonary veins in 92.0% and 3.2% of the patients, respectively. The percentage of right phrenic nerve, <5 mm from right atrium, superior caval vein, and superior caval vein-right atrium junction was 87.1%, 100%, and 62.9%, respectively. Left phrenic nerve was <5 mm from left atrial appendage, great cardiac vein, anterior and posterior interventricular veins, and left ventricular posterior veins in 81.9%, 1.0%, 39.1%, 28.6%, and 91.4% of the patients, respectively. Merely 0.06% left phrenic nerve had a distance <5 mm with left superior pulmonary vein, and none left phrenic nerve showed a distance <5 mm with left inferior pulmonary vein.
  
  
  
  One-stop enhanced CT scanning enabled detection of phrenic nerve anatomy, which might facilitate avoidance of the phrenic nerve-related complications in interventional electrophysiology.
authors.affiliation: Division of Radiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Yan-Jing
authors.initials: YJ
authors.lastname: Wang
authors.affiliation: Division of Radiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Division of Radiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Zhang
authors.affiliation: Division of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Sun
authors.affiliation: Division of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Division of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Institute, Changchun, Jilin, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; 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; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies
keywords: X-ray computer; anatomy; cardiac electrophysiology; phrenic nerve; tomography