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射频导管消融术后的干预后呼吸困难：考虑膈神经损伤。

Postintervention Dyspnea after Radiofrequency Catheter Ablation: Think of a Phrenic Nerve Injury.

作者信息

Ramos-Villalobos Liliana E, Colin Lizalde Luis, Márquez Manlio F, Iturralde Pedro, Castillo Francisco

机构信息

Department of Electrophysiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico.

Department of Cardiovascular Computer Tomography, Instituto Nacional de Cardiologia "Ignacio Chávez", Mexico City, Mexico.

出版信息

Case Rep Cardiol. 2017;2017:6418070. doi: 10.1155/2017/6418070. Epub 2017 Oct 4.

DOI:10.1155/2017/6418070
PMID:29109869
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5646315/
Abstract

Phrenic nerve injury (PNI) is a rare complication of catheter ablation therapy, most commonly observed in cryoablation of the right side pulmonary veins. We present a case of PNI after radiofrequency catheter ablation that developed acute dyspnea 24 hours after the intervention. Dyspnea is the main symptom of PNI, so the diagnosis should always be suspected if it appears after any type of catheter ablation involving the trajectory of the phrenic nerve. There is no specific treatment for PNI. The only maneuver that has been reported to accelerate the recovery of PNI is early stopping of the ablation therapy.

摘要

膈神经损伤（PNI）是导管消融治疗的一种罕见并发症，最常见于右侧肺静脉冷冻消融术中。我们报告一例射频导管消融术后发生的PNI病例，患者在干预后24小时出现急性呼吸困难。呼吸困难是PNI的主要症状，因此如果在任何涉及膈神经走行的导管消融术后出现，均应怀疑该诊断。PNI尚无特异性治疗方法。据报道，唯一能加速PNI恢复的措施是早期停止消融治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/156f4ae58481/CRIC2017-6418070.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/3c01d8e5536b/CRIC2017-6418070.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/7fa6c2ce90ac/CRIC2017-6418070.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/156f4ae58481/CRIC2017-6418070.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/3c01d8e5536b/CRIC2017-6418070.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/7fa6c2ce90ac/CRIC2017-6418070.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c22/5646315/156f4ae58481/CRIC2017-6418070.003.jpg

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本文引用的文献

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HeartRhythm Case Rep. 2017 Feb 5;3(4):199-204. doi: 10.1016/j.hrcr.2016.08.012. eCollection 2017 Apr.
2
Prospective Evaluation of Electromyography-Guided Phrenic Nerve Monitoring During Superior Vena Cava Isolation to Anticipate Phrenic Nerve Injury.上腔静脉隔离期间肌电图引导膈神经监测以预测膈神经损伤的前瞻性评估
J Cardiovasc Electrophysiol. 2016 Apr;27(4):390-5. doi: 10.1111/jce.12912. Epub 2016 Feb 8.
3
Strategies for phrenic nerve preservation during ablation of inappropriate sinus tachycardia.
不适当窦性心动过速消融术中膈神经保护策略。
Heart Rhythm. 2016 Jun;13(6):1238-1245. doi: 10.1016/j.hrthm.2016.01.021. Epub 2016 Jan 21.
4
Quantitative assessment of integrated phrenic nerve activity.膈神经综合活动的定量评估。
Respir Physiol Neurobiol. 2016 Jun;226:81-6. doi: 10.1016/j.resp.2015.12.005. Epub 2015 Dec 24.
5
Long-Term Results of Radiofrequency Hot Balloon Ablation in Patients With Paroxysmal Atrial Fibrillation: Safety and Rhythm Outcomes.阵发性心房颤动患者射频热球囊消融的长期结果：安全性和节律结果
J Cardiovasc Electrophysiol. 2015 Dec;26(12):1298-306. doi: 10.1111/jce.12820. Epub 2015 Oct 12.
6
Novel Technique to Prevent Phrenic Nerve Injury During Pulmonary Vein Isolation Using Preprocedural Imaging.使用术前成像预防肺静脉隔离期间膈神经损伤的新技术。
J Cardiovasc Electrophysiol. 2015 Oct;26(10):1057-62. doi: 10.1111/jce.12758. Epub 2015 Aug 27.
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Phrenic nerve injury: An underrecognized and potentially preventable complication of pulmonary vein isolation using a wide-area circumferential ablation approach.膈神经损伤：一种采用大面积环形消融方法进行肺静脉隔离时未被充分认识且可能可预防的并发症。
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