Author + information
- Received May 31, 2018
- Revision received July 19, 2018
- Accepted August 16, 2018
- Published online January 21, 2019.
- Kenji Okubo, MD,
- Nicola Trevisi, MD,
- Luca Foppoli, ME,
- Caterina Bisceglia, MD,
- Francesca Baratto, MD,
- Lorenzo Gigli, MD,
- Giuseppe D’Angelo, MD,
- Andrea Radinovic, MD,
- Manuela Cireddu, MD,
- Gabriele Paglino, MD,
- Patrizio Mazzone, MD and
- Paolo Della Bella, MD∗ ()
- ↵∗Address for correspondence:
Dr. Paolo Della Bella, Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Via Olgettina 60, Milan, Italy.
Objectives This study sought to investigate the incidence of phrenic nerve (PN) limitation and the utility of displacing the PN with a balloon.
Background The PN can limit the epicardial ablation of ventricular tachycardia (VT).
Methods From 2010 to 2017, 363 patients undergoing VT epicardial ablation at a single center were studied. Before the ablation, we used high output (20-mA) pacing maneuvers to verify the course of the PN. When we observed its capture, we used 1 of 3 different approaches to protect it: 1) non-balloon strategy (nerve-sparing ablation); 2) PN displacement with a small balloon (6 mm × 20 mm); or 3) PN displacement with a large balloon (20 mm × 45 mm).
Results PN capture occurred in 25 patients (7%) at the target ablation site. The most common cause was myocarditis (12 patients [48%]), and the incidence of the PN limitation was significantly higher in myocarditis than in other causes (19% vs. 4%, respectively; p = 0.0002). PN displacement was attempted in 7 patients by using large balloons and in 6 patients with small balloons, resulting in successful PN displacements and complete late potential (LP) abolition in 6 patients (86%) and 3 patients (50%), respectively. Among the 12 patients in whom the non-balloon strategy was used, only 1 patient (8%) achieved LP abolition (compared with the large balloon group; p = 0.002), whereas 3 patients experienced PN paralysis.
Conclusions The PN limited the epicardial ablation in 7% of patients. Because nerve-sparing ablations often resulted in PN injuries, a possible solution could be to displace the PN with a large balloon, leading to a safer procedure and completion of LP abolition.
Dr. Della Bella is a consultant for Abbott and Biosense; and has received research grants from Abbott, Biosense, Biotronik, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the author’s institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 31, 2018.
- Revision received July 19, 2018.
- Accepted August 16, 2018.
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