Texas Cardiac Arrhythmia Institute, St. Davids Medical Center, Austin, Texas, USA.
Heart Rhythm. 2010 Jul;7(7):937-41. doi: 10.1016/j.hrthm.2010.03.027. Epub 2010 Mar 25.
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.
We present a novel approach to locating the PN and predicting patients at higher risk of this complication.
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.
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.
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.
膈神经（PN）损伤是射频（RF）导管消融治疗心房颤动（AF）的一种已知并发症，在球囊基肺静脉隔离中更为常见。
我们提出了一种新的方法来定位 PN，并预测患者发生这种并发症的风险更高。
该研究包括两组患者。在第一组 71 例患者中，在 RF 消融术前获得计算机断层血管造影（CTA）和左心房（LA）三维重建。在轴位 CTA 图像上识别右心包膈动脉（RPA）的位置，并在三维图像上测量动脉到右上肺静脉（RSPV）口的距离。在消融过程中，通过起搏操作来识别右 PN 的位置。通过静脉造影测量 RSPV 口到 PN 的距离，并与 CTA 动脉测量值进行比较。在第二组中，使用相同的 PN 定位技术对 37 名参加 3 项研究性球囊消融试验的受试者的 CTA 成像进行分析，并与临床结果进行比较。在这项分析中，CTA 分割和 PN 定位是在不知道任何 PN 损伤的临床证据的情况下进行的。
PN 捕获与成像 RPA 之间的平均测量差异为 0.8mm（P =.539）。在所有情况下，成像的 RPA 都能可靠地确定右 PN 的大致位置（R-square 0.984，P <.001）。此外，这项分析表明，使用这些球囊消融设备，PN 位于 RSPV 口 10mm 以内的位置会增加 PN 损伤的风险。
成像右心包膈动脉可以可靠地定位右膈神经。该技术可能会识别出使用球囊基消融系统更容易发生膈神经损伤的解剖结构。
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