Step-by-Step Approach to Phrenic Nerve Displacement.

Phrenic nerve injury, though rare, can be a serious complication of catheter ablation leading to significant morbidity. The close proximity of the phrenic nerve to the site of origin of arrhythmias may also impact the success of catheter ablation. When the phrenic nerve is near the optimal site of ablation, several techniques have been proposed to create separation between the nerve and the epicardium, including the introduction of fluid, gas, and balloons. In this article, we present a step-by-step approach to phrenic nerve displacement to facilitate ablation, including a review of phrenic nerve anatomy, localization techniques, procedural strategies, and necessary equipment.