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Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation

Characterization and Outcome in a Multicenter Study

Frédéric Sacher, MD^_*,_*, Kristi H. Monahan, RN, Stuart P. Thomas, MD, Neil Davidson, MD, Pedro Adragao, MD^||, Prashanthan Sanders, MBBS, PhD^_*, Mélèze Hocini, MD^_*, Yoshihide Takahashi, MD^_*, Martin Rotter, MD^_*, Thomas Rostock, MD^_*, Li-Fern Hsu, MBBS^_*, Jacques Clémenty, MD^_*, Michel Haïssaguerre, MD^_*, David L. Ross, MD, Douglas L. Packer, MD and Pierre Jaïs, MD^_*

^_* Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux-Pessac, France
Division of Cardiac Electrophysiology, Mayo Clinic and Foundation, Rochester, Minnesota
Department of Cardiology, Westmead Hospital, Sydney, Australia
Department of Cardiology, Wythenshawe Hospital, Manchester, United Kingdom
^|| Department of Cardiology, Hospital Santa Cruz, Carnaxide, Portugal.

View larger version (139K): [in a new window]   Figure 1 Chest X-ray during inspiration before ablation (A), just after ablation with right phrenic nerve injury (B), and one year after ablation in inspiration (C, left) and expiration (C, right).

View larger version (60K): [in a new window]   Figure 2 Anatomic relationship between right phrenic nerve and heart (left) and left phrenic nerve and heart (right). 1 = right superior pulmonary vein; 2 = right inferior pulmonary vein; 3 = left atrial appendage. Figure is courtesy of Dr. Yen Ho (Royal Brompton Hospital).

View larger version (34K): [in a new window]   Figure 3 Endocardial site where phrenic nerve was captured in patients with phrenic nerve injury who had a redo procedure and completely recovered. (A) Endocardial right phrenic nerve course in the right atrium (RA) (Patient #12; posteroanterior view on anatomic Carto map). (B) Site where right and left phrenic nerve were captured in the left atrium (Patient #8; left anterior oblique [LAO] view on anatomic Carto map). RSPV = right superior pulmonary vein.