Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, 100029 Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chaoyang District, 100029 Beijing, China.
Europace. 2023 Apr 15;25(4):1352-1360. doi: 10.1093/europace/euad012.
This study aimed to evaluate the feasibility of real-time visualization and mapping of the right phrenic nerve (RPN) by using intracardiac echocardiography (ICE) during atrial fibrillation (AF) ablation.
RPN injury is a complication associated with the ablation of AF. Multiple approaches are currently being used to prevent and detect RPN injuries. However, none of these approaches can directly visualize the RPN in real-time during the ablation procedure.
The RPN was detected using ICE. The RPN and its adjacent structures were analysed. The relationship between the RPN's distance from the superior vena cava (SVC) and its pacing capture threshold was quantified. The safety of SVC isolation guided by the ICE-visualized RPN was evaluated. Thirty-eight people were enrolled in this study. The RPN was visualized by ICE in 92% of patients. It ran through the space between the SVC and the mediastinal pleura and had a 'straw'-like appearance upon ICE imaging. The course of the RPN was close to the SVC (minimum 1.0 ± 0.4 mm) and the right superior pulmonary vein (minimum 14.1 ± 7.3 mm). There was a positive linear correlation between the RPN's capture threshold and its distance from the SVC (Spearman's correlation coefficient = 0.728, < 0.001). SVC isolation was guided by the RPN; none of the patients developed an RPN injury.
RPN can be visualized by ICE in most patients, thus providing a novel approach for the real-time detection of RPN during AF ablation.
本研究旨在评估在心房颤动（AF）消融过程中使用心内超声心动图（ICE）实时可视化和定位右膈神经（RPN）的可行性。
RPN 损伤是与 AF 消融相关的并发症。目前有多种方法用于预防和检测 RPN 损伤。然而，这些方法都不能在消融过程中实时直接可视化 RPN。
使用 ICE 检测 RPN。分析 RPN 及其相邻结构。量化 RPN 距上腔静脉（SVC）的距离与其起搏捕获阈值之间的关系。评估 ICE 可视化 RPN 指导下 SVC 隔离的安全性。共有 38 名患者纳入本研究。92%的患者通过 ICE 可视化了 RPN。它穿过 SVC 和纵隔胸膜之间的空间，在 ICE 成像上呈现出“吸管”状外观。RPN 的走行靠近 SVC（最小 1.0±0.4mm）和右肺上静脉（最小 14.1±7.3mm）。RPN 捕获阈值与其距 SVC 的距离之间存在正线性相关（Spearman 相关系数=0.728，<0.001）。根据 RPN 指导 SVC 隔离，无患者发生 RPN 损伤。
ICE 可在大多数患者中可视化 RPN，从而为 AF 消融过程中实时检测 RPN 提供了一种新方法。
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