Epicardial Phrenic Nerve Displacement during Catheter Ablation of Atrial and XXXX : Procedural Experience and Outcomes.

@entity129 @entity1 @entity1165 @entity128 @entity591 @entity292 @entity955 @entity943
BACKGROUND: - @entity943 origin in close proximity to the @entity129 ( @entity129 ) can hinder successful catheter ablation. We describe our approach with @entity129 in such instances. METHODS AND RESULTS: - @entity129 displacement via percutaneous pericardial access was attempted in 13 @entity1 (age 49  16y, 9 females) with either @entity591 ( @entity591 ; 6 @entity1 ) or @entity955 triggered from a superior vena cava focus (1 @entity1 ) adjacent to the right @entity129 or epicardial @entity1165 ( @entity1165 ) origin adjacent to the left @entity129 (6 @entity1 ). An epicardially placed steerable sheath/4mm-catheter combination (5 @entity1 ) or a vascular or an esophageal balloon (8 @entity1 ) was ultimately successful. Balloon placement was often difficult requiring manipulation via a steerable sheath. In 2 @entity1165 cases, absence of @entity129 capture was achieved only once the balloon was directly over the ablation catheter. In 3 @entity591 @entity1 , @entity129 displacement was not possible with a balloon, however a steerable sheath/catheter combination was ultimately successful. @entity129 displacement allowed acute abolishment of all targeted @entity943 . No @entity128 occurred acutely or in follow up. Two @entity1 developed acute complications ( @entity292 1, pericardial bleeding 1). Survival free of target @entity943 was achieved in all @entity591 @entity1 , however a non-targeted @entity1165 recurred in 1 @entity1 at a median of 13 months' follow up. CONCLUSIONS: - @entity943 originating in close proximity to the @entity129 can be targeted successfully with @entity129 displacement with an epicardially placed steerable sheath/catheter combination, or balloon, but this strategy can be difficult to implement. Better tools for @entity129 protection are desirable.
