Abstract
Background: The SVC may require ablation to treat atrial fibrillation. Phrenic nerve proximity identified with pacing maneuvers may preclude ablation. Methods: We tested a new method using "cryo-mapping" to ablate despite nerve proximity. Results: Of 833 patients undergoing ablation, 110 (12%) had arrhythmogenic substrate at the SVC/RA junction. Of these 110 patients, 66 (60%) had consistent diaphragmatic stimulation when pacing at 10 mA at the prospective site of ablation. Of these 66 patients, 7 had continued arrhythmogenicity despite attempts to modify this substrate. For these 7 patients, we paced 4 cm into the SVC where consistent phrenic nerve stimulation was obtained, and cryoablation at -30°C was performed at sites requiring ablation. In 6 of 7 patients (86%), with continued diaphragmatic capture, cryoablation at -70/-80°C was then performed. In 1 of 7 patients (14%), diaphragmatic stimulation ceased at -30°C, and energy delivery stopped. In the 6 patients in whom cryoablation was completed, the arrhythmogenic substrate was successfully ablated without phrenic nerve injury. Conclusions: A novel "cryo-mapping" technique during phrenic nerve pacing can be used to successfully ablate arrhythmogenic substrate at the SVC/RA junction despite phrenic nerve proximity.
Original language | English (US) |
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Pages (from-to) | 23-30 |
Number of pages | 8 |
Journal | Journal of Interventional Cardiac Electrophysiology |
Volume | 22 |
Issue number | 1 |
DOIs | |
State | Published - Jun 2008 |
Keywords
- Atrial fibrillation
- Complications
- Cryoablation
- Phrenic nerve
- RF ablation
- Superior vena cava
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)