Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis
Background: Phrenic nerve injury is a serious complication of radiofrequency catheter ablation (RFA), potentially leading to diaphragmatic paralysis. Case Summary: A 42-year-old woman was admitted for an electrophysiological study and RFA for symptomatic supraventricular tachycardia using minimal co...
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Elsevier
2025-07-01
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| Series: | JACC: Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666084925003377 |
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| author | Pedro J. Diaz Delgado, MD Juan Carlos Batlle, MD Evan Saenger, DO Sergio Mellado, MD Juan Rodriguez Lopez, MD Hemal M. Nayak, MD Allen S. Anderson, MD Alejandro Velasco, MD |
| author_facet | Pedro J. Diaz Delgado, MD Juan Carlos Batlle, MD Evan Saenger, DO Sergio Mellado, MD Juan Rodriguez Lopez, MD Hemal M. Nayak, MD Allen S. Anderson, MD Alejandro Velasco, MD |
| author_sort | Pedro J. Diaz Delgado, MD |
| collection | DOAJ |
| description | Background: Phrenic nerve injury is a serious complication of radiofrequency catheter ablation (RFA), potentially leading to diaphragmatic paralysis. Case Summary: A 42-year-old woman was admitted for an electrophysiological study and RFA for symptomatic supraventricular tachycardia using minimal conscious sedation. During the electrophysiological study, atrial tachycardia was induced, showing early activation at the crista terminalis of the posterior right atrium. Persistent phrenic nerve capture with diaphragmatic stimulation was noted with pacing, which correlated with respiration and disappeared during inspiratory breath hold. A quadripolar catheter placed in the right subclavian vein was used to maintain phrenic nerve capture. RFA was successfully performed at the end of inspiration with careful monitoring of diaphragmatic stimulation facilitated by verbal commands. Postablation, atrial tachycardia was no longer inducible, and no complications occurred after the procedure or during outpatient follow-up. Discussion: Proximity of the phrenic nerve to right-sided atrial structures can complicate ablation for atrial tachycardia. This was managed by deep inspiration and displacement of right atrium away from the phrenic nerve, facilitating successful RFA. Take-Home Message: Performing ablation during end inspiration with phrenic nerve displacement was effective and safe. |
| format | Article |
| id | doaj-art-5a490e7d264d4a8db7cab19f3c1ef0c2 |
| institution | Kabale University |
| issn | 2666-0849 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Case Reports |
| spelling | doaj-art-5a490e7d264d4a8db7cab19f3c1ef0c22025-08-20T03:29:34ZengElsevierJACC: Case Reports2666-08492025-07-01301710355910.1016/j.jaccas.2025.103559Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve ParalysisPedro J. Diaz Delgado, MD0Juan Carlos Batlle, MD1Evan Saenger, DO2Sergio Mellado, MD3Juan Rodriguez Lopez, MD4Hemal M. Nayak, MD5Allen S. Anderson, MD6Alejandro Velasco, MD7University of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USA; Address for correspondence: Dr Pedro Javier Diaz Delgado, University of Texas Health at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA.Yale University School of Medicine, Department of Medicine, New Haven, Connecticut, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USAUniversity of Texas Health at San Antonio, Department of Medicine, Division of Cardiology, San Antonio, Texas, USABackground: Phrenic nerve injury is a serious complication of radiofrequency catheter ablation (RFA), potentially leading to diaphragmatic paralysis. Case Summary: A 42-year-old woman was admitted for an electrophysiological study and RFA for symptomatic supraventricular tachycardia using minimal conscious sedation. During the electrophysiological study, atrial tachycardia was induced, showing early activation at the crista terminalis of the posterior right atrium. Persistent phrenic nerve capture with diaphragmatic stimulation was noted with pacing, which correlated with respiration and disappeared during inspiratory breath hold. A quadripolar catheter placed in the right subclavian vein was used to maintain phrenic nerve capture. RFA was successfully performed at the end of inspiration with careful monitoring of diaphragmatic stimulation facilitated by verbal commands. Postablation, atrial tachycardia was no longer inducible, and no complications occurred after the procedure or during outpatient follow-up. Discussion: Proximity of the phrenic nerve to right-sided atrial structures can complicate ablation for atrial tachycardia. This was managed by deep inspiration and displacement of right atrium away from the phrenic nerve, facilitating successful RFA. Take-Home Message: Performing ablation during end inspiration with phrenic nerve displacement was effective and safe.http://www.sciencedirect.com/science/article/pii/S2666084925003377ablationpalpitationssupraventricular tachycardia |
| spellingShingle | Pedro J. Diaz Delgado, MD Juan Carlos Batlle, MD Evan Saenger, DO Sergio Mellado, MD Juan Rodriguez Lopez, MD Hemal M. Nayak, MD Allen S. Anderson, MD Alejandro Velasco, MD Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis JACC: Case Reports ablation palpitations supraventricular tachycardia |
| title | Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis |
| title_full | Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis |
| title_fullStr | Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis |
| title_full_unstemmed | Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis |
| title_short | Radiofrequency Ablation of Crista Terminalis Focal Atrial Tachycardia Using End Inspiration to Prevent Phrenic Nerve Paralysis |
| title_sort | radiofrequency ablation of crista terminalis focal atrial tachycardia using end inspiration to prevent phrenic nerve paralysis |
| topic | ablation palpitations supraventricular tachycardia |
| url | http://www.sciencedirect.com/science/article/pii/S2666084925003377 |
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