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Cryoablation of Focal Tachycardia Originating from the Right Atrial Free Wall during Upstream Phrenic Pacing to Avoid Phrenic Nerve Injury
Author(s) -
JOHNSRUDE CHRISTOPHER
Publication year - 2015
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12527
Subject(s) - cryoablation , medicine , phrenic nerve , ablation , atrial tachycardia , tachycardia , catheter ablation , cardiology , anesthesia , radiofrequency ablation , catheter , surgery , respiratory system
Background Recognition of the potential for phrenic nerve injury (PNI) often prompts less aggressive attempts at catheter ablation of multiple forms of tachycardia or abandoning ablation altogether. Some novel techniques to avoid PNI during catheter ablation have been described. Methods Five patients (age: 13–57 years, three females) with ectopic atrial tachycardia originating from the right atrial free wall (RAFW) near the phrenic nerve underwent electrophysiology study with three‐dimensional mapping and endocardial cryoablation. Upstream phrenic pacing was performed after cryoadherence was achieved, and cryoablation of ectopic foci was performed during close observation for occurrence of PNI and tachycardia elimination. Results Cryoablation acutely eliminated five of six atrial tachycardias originating close to the phrenic nerve. Transient PNI during cryothermy occurred in two patients, and resolved within 3 minutes. Patients were observed overnight on telemetry, with no early recurrences of targeted atrial tachycardias and no evidence of PNI. At last follow‐up of 1–39 months, four patients were arrhythmia free on no medications. Conclusions Catheter cryoablation during simultaneous upstream phrenic nerve pacing can lead to safe and effective elimination of focal atrial tachycardias originating from the RAFW close to the phrenic nerve.