Anatomic structures such as the accessory nerve, the phrenic nerve, parts of the brachial plexus, the jugular vein, or the clavicle were resected in the other 2 (40%) patients.
The possibility of phrenic nerve injury must be considered carefully, and preoperative discussion with the patient is mandatory concerning the radicality of the resection.
Although rare, cervical nerve root compression as a cause of phrenic nerve
palsy should be considered in patients presenting with hemidiaphragm paralysis and respiratory symptoms as surgical management can result in resolution of paralysis and potential improvement in respiratory symptoms.
Cabrera, "Anatomic evaluation of the left phrenic nerve
relevant to epicardial and endocardial catheter ablation: implications for phrenic nerve
injury," Heart Rhythm, vol.
As routinely for RFCA, no phrenic nerve stimulation was performed during ablation of right pulmonary veins.
The mechanism of the occurrence of PNI is probably related to positioning the balloon further into the right pulmonary veins, as the phrenic nerve may run behind the right atrium.
described the close relationship between the atrial tissue surrounding the right superior pulmonary vein (RSPV) at its inferoanterior area, the RSPV, and the SVC with the phrenic nerve (Figure 3).
Early detection of PNI with phrenic nerve pacing is now the standard procedure during cryoablation in order to detect PNI earlier, to stop cryotherapy immediately, and to accelerate recovery of the injured nerve.
Stephenson et al., "Phrenic nerve injury after catheter ablation of atrial fibrillation," Indian Pacing and Electrophysiology Journal, vol.
Nakamura et al., "Prospective evaluation of electromyography-guided phrenic nerve monitoring during superior vena cava isolation to anticipate phrenic nerve injury," Journal of Cardiovascular Electrophysiology, vol.