Right phrenic nerve palsy following transcatheter radiofrequency current atrial fibrillation ablation: Case report

Abstract

Phrenic nerve palsy (PNP) is a well-known complication of cardiac surgery or jugular/subclavian vein catheterization, presenting with cough, hiccups, dyspnoea/shortness of breath and, in some cases, ventilatory failure. Rarely, PNP is a complication of transcatheter radiofrequency ablation for atrial fibrillation. This report describes the case of a 72-year-old woman with a 2-year history of recurrent paroxysmal atrial fibrillation associated with occasional palpitations and shortness of breath who underwent routine transcatheter radiofrequency ablation. Three days after the procedure, the patient developed shortness of breath and progressive dyspnoea. Motor nerve conduction showed the absence of the right phrenic nerve compound motor action potential compared with the normal left side confirming the diagnosis of a right phrenic nerve palsy. This current case demonstrated the importance of undertaking an electrophysiological evaluation of phrenic nerve conduction after transcatheter radiofrequency ablation in patients presenting with palpitations and shortness of breath even if present a few days after the procedure.

Transient phrenic nerve palsy induced by cardiac catheterisation in an infant

“…Catheterisation-related phrenic nerve palsy was well-known complications for pulmonary vein isolation of radiofrequency catheter ablation. 4 Phrenic nerve paralysis is also a rare complication associated with central venous catheterisation or cardiac electronic device implantation due to the anatomical position between the central vein and the phrenic nerve. 3,5,6 It may be difficult to detect phrenic nerve palsy under general anaesthesia because the symptoms will be masked by mechanical respiration.…”

“…In unilateral phrenic nerve palsy as in our case, patients are usually asymptomatic, have a good prognosis, and do not always need treatment. 4 However, some patients experience severe heart failure or severe respiratory failure, are sometimes symptomatic, and need oxygen therapy or respiratory support.…”