Detection of Phrenic Nerves and Their Relation to Cardiac Anatomy Using 64-Slice Multidetector Computed Tomography

Matsumoto, Yuji; Krishnan, Subramaniam; Fowler, Steven J.; Saremi, Farhood; Kondo, Takeshi; Ahsan, Chowdhury; Narula, Jagat; Gurudevan, Swaminatha V.

doi:10.1016/j.amjcard.2007.01.072

Cited by 77 publications

(47 citation statements)

References 18 publications

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“…A previous study had reported that the PN could be identified in 74% of patients, and that the patients in whom PN was not detected were older and more commonly women. 18 The discrepancy between our results and those from this previous study may be explained by the differences between the studied populations, and particularly by the limited number of women included in this study (9/74). The relationship with epicardial fat has not been previously studied, and could be explained by the increased contrast between PN and surrounding tissues in the presence of fat.…”

Section: Visualization Of the Left Pn On Mdctcontrasting

confidence: 56%

Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Yamashita

Sacher

Mahida

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Epicardial ventricular tachycardia (VT) ablation is associated with risks of coronary artery (CA) and phrenic nerve (PN) injury. We investigated the role of multidetector computed tomography in visualizing CA and PN during VT ablation. Methods and Results-Ninety-five consecutive patients (86 men; age, 57±15) with VT underwent cardiac multidetector computed tomography. The PN detection rate and anatomic variability were analyzed. In 49 patients undergoing epicardial mapping, real-time multidetector computed tomographic integration was used to display CAs/PN locations in 3-dimensional mapping systems. Elimination of local abnormal ventricular activities (LAVAs) was used as ablation end point.

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Section: Visualization Of the Left Pn On Mdctcontrasting

confidence: 56%

Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Yamashita

Sacher

Mahida

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Anatomical, 14,15 radiological, 16 and electrophysiological 17 research regarding the PN and relevant to cardiovascular therapy has been performed. To our knowledge, however, there are no studies examining the long-range anatomical course of the preoperatively visualized PN using 3-D electroanatomical mapping.…”

Section: Discussionmentioning

confidence: 99%

“…Matsumoto et al 16 reported that the right and the left PBs could be identified in 47 and 74% of 106 patients who underwent cardiovascular CT with contrast dye, respectively. In our study, bilateral PBs were detected in all 10 cases.…”

Section: -D Imaging and Mapping Of The Right And Left Pnsmentioning

confidence: 99%

Three-dimensional imaging and mapping of the right and left phrenic nerves: relevance to interventional cardiovascular therapy

Fukumoto¹,

Takatsuki²,

Jinzaki³

et al. 2013

EP Europace

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AimsPhrenic nerves (PNs) can be damaged during interventional cardiovascular therapy because of the nerves' proximity to the heart. This study aimed to analyse the anatomy of the PN by performing three-dimensional (3-D) imaging and pace mapping. Methods and resultsForty consecutive patients with atrial fibrillation referred for catheter ablation were enrolled in this study and underwent preoperative cardiovascular computed tomography (CT). In 10 patients with sinus rhythm during tomography, 3-D images of the right and left pericardiophrenic bundles (PBs), consisting of the ipsilateral PN and accompanying vessels, were reconstructed from the CT data. During the electrophysiological study, PN pace mapping was performed from both atria. The course of the PBs generated by CT imaging and the PN pace map generated by the 3-D mapping system were compared. By electrical pacing, the PNs were captured in 40 individuals (100%) from the superior vena cava and the right atrium, and in 17 patients (43%) from the left atrial appendage. Clear 3-D images of PBs were reconstructed in all cases in which CT-reconstruction was performed. The distance between the locations of the right PB generated by CT imaging and those of the right PN-capture sites in the right-sided heart on the mapping system was 8.7 + 5.8 mm. ConclusionsThe 3-D routes of the bilateral PNs passing near the heart were verified by pace mapping. The preoperatively reconstructed 3-D course of the PB succeeded in locating the PN, which may facilitate the comprehension of PN anatomy to avoid its injury during interventional cardiovascular therapy.--

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“…Matsumoto uses this consistent relationship to define the right and left pericardiophrenic bundles (RPCB and LPCB). 63 The LPCB was visible in 74% of patients with frequent contact on the left atrial appendage. The LPCB was identified most effectively on axial images at the level of the lateral left ventricular wall as a rounded structure with variable density.…”

Section: Journal Of Atrial Fibrillationmentioning

confidence: 99%

The Phrenic Nerve and Atrial Fibrillation Ablation Procedures

Asirvatham¹,

Mears²,

Lachman³

et al. 2009

J.A.F.I.B

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Radiofrequency ablation is increasingly used as an option to optimally manage patients with symptomatic atrial fibrillation. Presently, ablationists strive to improve success rates, particularly with persistent atrial fibrillation, while simultaneously attempting to reduce complications. A well-recognized complication with atrial fibrillation ablation is injury to the phrenic nerve giving rise to diaphragmatic paresis and patient discomfort.Phrenic nerve damage may occur when performing common components of atrial fibrillation ablation including pulmonary and superior vena caval isolation. The challenge for ablationists is to successfully target the arrhythmogenic substrate while avoiding this complication. In order to do this, a thorough knowledge of phrenic nerve anatomy, points in the ablation procedure where nerve damage is more likely, and an understanding of the presently utilized techniques to avoid this complication is required. In addition, when this complication does arise, prompt recognition of its occurrence, knowledge of the natural history, and available methods for management are needed.In this review, we discuss the underlying anatomic principles, techniques of avoiding phrenic nerve damage, and presently available methods of diagnosing and managing this complication.

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Detection of Phrenic Nerves and Their Relation to Cardiac Anatomy Using 64-Slice Multidetector Computed Tomography

Cited by 77 publications

References 18 publications

Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Role of High-Resolution Image Integration to Visualize Left Phrenic Nerve and Coronary Arteries During Epicardial Ventricular Tachycardia Ablation

Three-dimensional imaging and mapping of the right and left phrenic nerves: relevance to interventional cardiovascular therapy

The Phrenic Nerve and Atrial Fibrillation Ablation Procedures

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