Cardiology Division, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku city, Tokyo, Japan.
Europace. 2013 Jul;15(7):937-43. doi: 10.1093/europace/eus439. Epub 2013 Jan 15.
Phrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping.
Forty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 ± 5.8 mm.
The 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy.
由于心脏附近的神经位置，膈神经（PN）在心血管介入治疗中可能会受损。本研究旨在通过三维（3-D）成像和起搏图来分析 PN 的解剖结构。
连续纳入 40 例因心房颤动而接受导管消融治疗的患者，所有患者均接受术前心血管计算机断层扫描（CT）。在 10 例窦性心律的患者中，从 CT 数据重建了右侧和左侧心包膈束（PBs）的 3-D 图像，包括同侧 PN 和伴随的血管。在电生理研究期间，从两个心房进行 PN 起搏图描记。比较 CT 成像生成的 PB 轨迹和 3-D 映射系统生成的 PN 起搏图。通过电起搏，在 40 个人（100%）中从上腔静脉和右心房捕获 PN，在 17 名患者（43%）中从左心耳捕获 PN。在所有进行 CT 重建的病例中均成功重建了 PB 的清晰 3-D 图像。CT 成像生成的右侧 PB 位置与映射系统上右侧心脏 PN 捕获部位之间的距离为 8.7 ± 5.8mm。
通过起搏图证实了双侧 PN 靠近心脏的 3-D 路径。术前重建的 PB 3-D 路径成功定位了 PN，这有助于理解 PN 解剖结构，避免在心血管介入治疗中损伤 PN。
