Atrial fibrillation ablation has emerged as an
effective tool in the management of symptomatic atrial fibrillation. Currently,
the eletrophysiologists are striving to maximize the success while minimizing
complications. Phrenic nerve injury (PNI) is one of the concerning
complications, especially in cases of cryo-balloon ablation. Due to anatomical
proximity to atrial tissue, phrenic nerve is particularly susceptible to injury.
With evolving monitoring techniques it is now possible to minimize the
likelihood of a permanent PNI. However, the challenge remains to detect PNI at
the earliest and to avoid further damage to the nerve. In this review, we
discuss pertinent anatomical principles, techniques to avoid PNI and management
in cases where PNI is encountered.
Credits: Valay Parikh; Marcin Kowalski