Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography

Implications for balloon-based procedures

Rodney Horton, Luigi Di Biase, Vivek Reddy, Petr Neuzil, Prasant Mohanty, Javier Sanchez, Tuan Nguyen, Sanghamitra Mohanty, G. Joseph Gallinghouse, Shane M. Bailey, Jason D. Zagrodzky, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Phrenic nerve (PN) injury, a known complication of radiofrequency (RF) catheter ablation of atrial fibrillation (AF), has been more commonly reported with balloon-based pulmonary vein isolation. Objective: We present a novel approach to locating the PN and predicting patients at higher risk of this complication. Methods: The study included 2 groups of patients. In the first group of 71 patients, computerized tomographic angiography (CTA) with 3-dimensional reconstruction of the left atrium (LA) was obtained prior to an RF ablation procedure. The location of the right pericardiophrenic artery (RPA) was identified on the axial CTA images, and the artery distance to the right superior pulmonary vein (RSPV) ostium was measured in the 3-dimensional image. During ablation, the location of the right PN was identified by pacing maneuvers. The distance to the ostium of the RSPV was measured by venography and compared with the CTA artery measurement. In the second group, CTA imaging from 37 subjects who were enrolled in 3 investigational balloon ablation trials were analyzed using the same PN location technique and compared against the clinical outcomes. In this analysis, the CTA segmentation and PN location was performed in a blinded fashion as to any clinical evidence of PN injury. Results: The mean measurement difference between PN capture and imaged RPA was 0.8 mm (P = .539). In all cases, the imaged RPA could reliably identify the approximate location of the right PN (R-square 0.984, P < .001). Moreover, this analysis suggests that a PN location within 10 mm of the RSPV poses a higher risk of PN injury using these balloon ablation devices. Conclusion: Imaging the right pericardiophrenic artery can reliably locate the right phrenic nerve. This technique might identify anatomy more vulnerable to phrenic nerve injury using balloon-based ablation systems.

Original languageEnglish (US)
Pages (from-to)937-941
Number of pages5
JournalHeart Rhythm
Volume7
Issue number7
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Phrenic Nerve
Angiography
Arteries
Pulmonary Veins
Wounds and Injuries
Catheter Ablation
Phlebography
Heart Atria
Atrial Fibrillation
Anatomy

Keywords

  • Ablation
  • Atrial fibrillation
  • Balloon
  • Computerized tomographic angiography
  • Paralysis
  • Phrenic nerve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography : Implications for balloon-based procedures. / Horton, Rodney; Di Biase, Luigi; Reddy, Vivek; Neuzil, Petr; Mohanty, Prasant; Sanchez, Javier; Nguyen, Tuan; Mohanty, Sanghamitra; Gallinghouse, G. Joseph; Bailey, Shane M.; Zagrodzky, Jason D.; Burkhardt, J. David; Natale, Andrea.

In: Heart Rhythm, Vol. 7, No. 7, 07.2010, p. 937-941.

Research output: Contribution to journalArticle

Horton, R, Di Biase, L, Reddy, V, Neuzil, P, Mohanty, P, Sanchez, J, Nguyen, T, Mohanty, S, Gallinghouse, GJ, Bailey, SM, Zagrodzky, JD, Burkhardt, JD & Natale, A 2010, 'Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography: Implications for balloon-based procedures', Heart Rhythm, vol. 7, no. 7, pp. 937-941. https://doi.org/10.1016/j.hrthm.2010.03.027
Horton, Rodney ; Di Biase, Luigi ; Reddy, Vivek ; Neuzil, Petr ; Mohanty, Prasant ; Sanchez, Javier ; Nguyen, Tuan ; Mohanty, Sanghamitra ; Gallinghouse, G. Joseph ; Bailey, Shane M. ; Zagrodzky, Jason D. ; Burkhardt, J. David ; Natale, Andrea. / Locating the right phrenic nerve by imaging the right pericardiophrenic artery with computerized tomographic angiography : Implications for balloon-based procedures. In: Heart Rhythm. 2010 ; Vol. 7, No. 7. pp. 937-941.
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abstract = "Background: Phrenic nerve (PN) injury, a known complication of radiofrequency (RF) catheter ablation of atrial fibrillation (AF), has been more commonly reported with balloon-based pulmonary vein isolation. Objective: We present a novel approach to locating the PN and predicting patients at higher risk of this complication. Methods: The study included 2 groups of patients. In the first group of 71 patients, computerized tomographic angiography (CTA) with 3-dimensional reconstruction of the left atrium (LA) was obtained prior to an RF ablation procedure. The location of the right pericardiophrenic artery (RPA) was identified on the axial CTA images, and the artery distance to the right superior pulmonary vein (RSPV) ostium was measured in the 3-dimensional image. During ablation, the location of the right PN was identified by pacing maneuvers. The distance to the ostium of the RSPV was measured by venography and compared with the CTA artery measurement. In the second group, CTA imaging from 37 subjects who were enrolled in 3 investigational balloon ablation trials were analyzed using the same PN location technique and compared against the clinical outcomes. In this analysis, the CTA segmentation and PN location was performed in a blinded fashion as to any clinical evidence of PN injury. Results: The mean measurement difference between PN capture and imaged RPA was 0.8 mm (P = .539). In all cases, the imaged RPA could reliably identify the approximate location of the right PN (R-square 0.984, P < .001). Moreover, this analysis suggests that a PN location within 10 mm of the RSPV poses a higher risk of PN injury using these balloon ablation devices. Conclusion: Imaging the right pericardiophrenic artery can reliably locate the right phrenic nerve. This technique might identify anatomy more vulnerable to phrenic nerve injury using balloon-based ablation systems.",
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AU - Neuzil, Petr

AU - Mohanty, Prasant

AU - Sanchez, Javier

AU - Nguyen, Tuan

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AU - Gallinghouse, G. Joseph

AU - Bailey, Shane M.

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