First report of phrenic nerve injury during pulmonary vein isolation using the Ablation Frontiers pulmonary vein ablation catheter

  • Syed Y. Ahsan
  • Andrew S. Flett
  • Pier D. Lambiase
  • Oliver R. SegalEmail author


In an attempt to improve procedural outcomes and reduce time and complications, there has been particular interest in alternative technologies specifically designed for atrial fibrillation (AF) ablation. One novel technique is isolation of the pulmonary veins using an over-the-wire multielectrode catheter delivering duty-cycled bipolar and unipolar radiofrequency energy. Phrenic nerve injury is a rare but significant complication of AF ablation. This is the first report of phrenic nerve injury following catheter ablation for AF using the Pulmonary Vein Ablation Catheter (Medtronic, Minneapolis, MN, USA).


Radiofrequency ablation Atrial Fibrillation Paroxysmal Pulmonary vein ablation catheter Phrenic nerve injury 

Supplementary material

10840_2010_9517_MOESM1_ESM.avi (15.4 mb)
ESM 1 (AVI 15,719 kb)


  1. 1.
    Fisher, J. D., Spinelli, M. A., Mookherjee, D., Krumerman, A. K., & Palma, E. C. (2006). Atrial fibrillation ablation: reaching the mainstream. Pacing and Clinical Electrophysiology, 29, 523–537.CrossRefPubMedGoogle Scholar
  2. 2.
    Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2005). Worldwide survey on the methods, efficacy and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.CrossRefPubMedGoogle Scholar
  3. 3.
    Sanchez-Quintana, D., Cabrera, J. A., Climent, V., Farre, J., Weiglein, A., & Ho, S. Y. (2005). How close are the phrenic nerves to cardiac structures? Implication for cardiac interventionalists. Journal of Cardiovascular Electrophysiology, 16(3), 309–313.CrossRefPubMedGoogle Scholar
  4. 4.
    Sacher, F., Monahan, K., Thomas, S., Davidson, N., Adragao, P., & Sanders, P. (2006). Phrenic nerve injury after atrial fibrillation catheter ablation. Characterization and outcome in a multicentre study. Journal of the American College of Cardiology, 47, 2498–2503.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee, B. K., Choi, K. J., Kim, J., Rhee, K. S., Nam, G. B., & Kim, Y. H. (2004). Right phrenic nerve injury following electrical disconnection of the right superior pulmonary vein. Pacing and Clinical Electrophysiology, 27, 1444–1446.CrossRefPubMedGoogle Scholar
  6. 6.
    Bai, R., Patel, D., Di Biase, L., Fahmy, T. S., Kozeluhova, M., Prasad, S., et al. (2006). Phrenic nerve injury after catheter ablation: should we worry about this complication? Journal of Cardiovascular Electrophysiology, 17, 944–948.CrossRefPubMedGoogle Scholar
  7. 7.
    Haines, D. E., & Watson, D. D. (1989). Tissue heating during radiofrequency catheter ablation: a thermodynamic model and observations in isolated perfused and superfused canine right ventricular free wall. Pacing and Clinical Electrophysiology, 12, 962–976.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsong, T. Y., & Su, Z. D. (1999). Biological effects of electric shock and heat denaturation and oxidation of molecules, membranes and cellular functions. Annals of the New York Academy of Sciences, 888, 211–232.CrossRefPubMedGoogle Scholar
  9. 9.
    Holden, A. V., & Biktashev, V. N. (2002). Computational biology of propagation in excitable media: models of cardiac tissue. Chaos Solitons Fractals, 13, 1643–1658.CrossRefGoogle Scholar
  10. 10.
    Bunch, T. J., Bruce, G. K., Mahaptra, S., Johnson, S., Miller, D., Sarabanda, A., et al. (2005). Mechanisms of phrenic nerve injury during radiofrequency ablation at the pulmonary vein orifice. Journal of Cardiovascular Electrophysiology, 16, 1318–1325.CrossRefPubMedGoogle Scholar
  11. 11.
    Natale, A., Pisano, E., Shewchik, J., Bash, D., Fanelli, R., Potenza, D., et al. (2000). First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation, 102, 1879–1882.PubMedGoogle Scholar
  12. 12.
    Su, W. W., Johnson, S. B., & Packer, D. L. (2002). Collateral damage from circumferential laser energy ablation of pulmonary veins. European Heart Journal, 23, 522.Google Scholar
  13. 13.
    Tse, H. F., Reek, S., Timmermans, C., Lee, K. L., Geller, J. C., Rodriguez, L. M., et al. (2003). Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. Journal of the American College of Cardiology, 42, 752–758.CrossRefPubMedGoogle Scholar
  14. 14.
    Sarabanda, A. V., Bunch, T. J., Johnson, S. B., Mahapatra, S., Milton, M., Leite, L., et al. (2005). Efficacy and safety of circumferential pulmonary vein isolation using a novel cryothermal balloon ablation system. Journal of the American College of Cardiology, 46, 1902–1912.CrossRefPubMedGoogle Scholar
  15. 15.
    Boersma, L. V., Wijffels, M. C., Oral, H., Wever, E. F., & Morady, F. (2008). Pulmonary vein isolation by duty-cycled bipolar and unipolar radiofrequency energy with a multielectrode ablation catheter. Heart Rhythm, 5, 1635–1642.CrossRefPubMedGoogle Scholar
  16. 16.
    Wijfells, M. C., Oosterhout, M. V., Boersma, L. V., Werneth, R., Kunis, C., Hu, B., et al. (2009). Characterization of in vitro and in vivo lesions made by a novel multichannel ablation generator and a circumlinear decapolar ablation catheter. J Cardiovasc Electrophysiol, 20(10), 1142–1148.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Syed Y. Ahsan
    • 1
  • Andrew S. Flett
    • 1
  • Pier D. Lambiase
    • 1
  • Oliver R. Segal
    • 1
    • 2
    Email author
  1. 1.The Heart HospitalUniversity College LondonLondonUK
  2. 2.Department of Cardiovascular ElectrophysiologyThe Heart HospitalLondonUK

Personalised recommendations