Phrenic Nerve Limitation During Epicardial Catheter Ablation of Ventricular Tachycardia
| Autor: | Paolo Della Bella, Manuela Cireddu, Lorenzo Gigli, Giuseppe D'Angelo, Kenji Okubo, Luca Foppoli, Patrizio Mazzone, Andrea Radinovic, Caterina Bisceglia, Nicola Trevisi, Gabriele Paglino, Francesca Baratto |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Epicardial Mapping Male medicine.medical_specialty Myocarditis medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Ventricular tachycardia Single Center Balloon Cardiac Catheters 03 medical and health sciences 0302 clinical medicine Internal medicine Paralysis Medicine Humans 030212 general & internal medicine Phrenic nerve Aged business.industry Middle Aged Ablation medicine.disease Phrenic Nerve Cardiology Catheter Ablation Tachycardia Ventricular Female medicine.symptom business |
| Zdroj: | JACC. Clinical electrophysiology. 5(1) |
| ISSN: | 2405-5018 |
| Popis: | Objectives This study sought to investigate the incidence of phrenic nerve (PN) limitation and the utility of displacing the PN with a balloon. Background The PN can limit the epicardial ablation of ventricular tachycardia (VT). Methods From 2010 to 2017, 363 patients undergoing VT epicardial ablation at a single center were studied. Before the ablation, we used high output (20-mA) pacing maneuvers to verify the course of the PN. When we observed its capture, we used 1 of 3 different approaches to protect it: 1) non-balloon strategy (nerve-sparing ablation), 2) PN displacement with a small balloon (6 mm × 20 mm), or 3) PN displacement with a large balloon (20 mm × 45 mm). Results PN capture occurred in 25 patients (7%) at the target ablation site. The most common cause was myocarditis (12 patients [48%]), and the incidence of the PN limitation was significantly higher in myocarditis than in other causes (19% vs. 4%, respectively; p = 0.0002). PN displacement was attempted in 7 patients by using large balloons and in 6 patients with small balloons, resulting in successful PN displacements and complete late potential (LP) abolition in 6 patients (86%) and 3 patients (50%), respectively. Among the 12 patients in whom the non-balloon strategy was used, only 1 patient (8%) achieved LP abolition (compared with the large balloon group; p = 0.002), whereas 3 patients experienced PN paralysis. Conclusions The PN limited the epicardial ablation in 7% of patients. Because nerve-sparing ablations often resulted in PN injuries, a possible solution could be to displace the PN with a large balloon, leading to a safer procedure and completion of LP abolition. |
| Databáze: | OpenAIRE |
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