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Phrenic nerve injury contemporaneous with acute decrease in compound motor action potential during laser balloon pulmonary vein isolation for atrial fibrillation 

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Presentation on theme: "Phrenic nerve injury contemporaneous with acute decrease in compound motor action potential during laser balloon pulmonary vein isolation for atrial fibrillation "— Presentation transcript:

1 Phrenic nerve injury contemporaneous with acute decrease in compound motor action potential during laser balloon pulmonary vein isolation for atrial fibrillation  Takahiko Nagase, MD, So Asano, MD, Koji Goto, MD, Yoshifumi Ikeda, MD, Ritsushi Kato, MD, Kazuo Matsumoto, MD  HeartRhythm Case Reports  Volume 5, Issue 2, Pages (February 2019) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Baseline 12-lead electrocardiogram in sinus rhythm (top) and paroxysmal atrial fibrillation (bottom) before ablation. B: Chest radiographs of posterior-anterior view (top) and right-left view (bottom) before ablation. HeartRhythm Case Reports 2019 5, 83-87DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Selective angiogram of the right superior pulmonary vein. B: Balloon position and endoscopic view at the time of sudden decline in compound motor action potential (CMAP). Left: CMAP was obtained while pacing the circular mapping catheter positioned at the superior vena cava. Middle: Laser balloon was positioned at the left atrial antral position. Right: Endoscopic view. CMAP was suddenly reduced at the anterior part of the right superior pulmonary vein. C: Left: Intracardiac electrocardiogram. A stable CMAP amplitude was confirmed before laser energy titration to the right superior pulmonary vein. Right: CMAP showed a sudden reduction >30% of baseline amplitude (black arrows, 0.61–0.67 mV) in only 2.4 seconds (red arrow, 0.42 mV) during titration to the anterior wall of the right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 83-87DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Chest radiographs of posterior-anterior view (left) and right-left view (right) on the day after ablation. The right diaphragm was mildly elevated. B: Chest radiographs of posterior-anterior view (left) and right-left view (middle) and computed tomography scan (right) 1 month after ablation. The right diaphragm was still elevated with a mild right atelectasis. HeartRhythm Case Reports 2019 5, 83-87DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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