Radiofrequency ablation is
increasingly used as an option to optimally manage patients with symptomatic
atrial fibrillation. Presently,
ablationists strive to improve success rates, particularly with persistent
atrial fibrillation, while simultaneously attempting to reduce
complications. A well-recognized
complication with atrial fibrillation ablation is injury to the phrenic nerve
giving rise to diaphragmatic paresis and patient discomfort.
Phrenic nerve damage may occur when
performing common components of atrial fibrillation ablation including
pulmonary and superior vena caval isolation. The challenge for ablationists is to successfully target the
arrhythmogenic substrate while avoiding this complication. In order to do this, a thorough knowledge of
phrenic nerve anatomy, points in the ablation procedure where nerve damage is
more likely, and an understanding of the presently utilized techniques to avoid
this complication is required.
In addition, when this complication
does arise, prompt recognition of its occurrence, knowledge of the natural
history, and available methods for management are needed.
In this review, we discuss the
underlying anatomic principles, techniques of avoiding phrenic nerve damage,
and presently available methods of diagnosing and managing this
Credits: Jennifer A. Mears, BS; Nirusha Lachman, PhD; Kevin Christensen; Samuel J. Asirvatham MD, FACC, FHRS