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Successful use of “cryo-mapping” to avoid phrenic nerve damage during ostial superior vena caval ablation despite nerve proximity

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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.

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Authors and Affiliations

  1. Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Chadi Dib & Suraj Kapa

  2. Division of Cardiovascular Diseases and Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Brian D. Powell, Douglas L. Packer & Samuel J. Asirvatham

  3. Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA

    Samuel J. Asirvatham

Authors
  1. Chadi Dib
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  2. Suraj Kapa
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  3. Brian D. Powell
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  4. Douglas L. Packer
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  5. Samuel J. Asirvatham
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Corresponding author

Correspondence to Samuel J. Asirvatham.

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Dib, C., Kapa, S., Powell, B.D. et al. Successful use of “cryo-mapping” to avoid phrenic nerve damage during ostial superior vena caval ablation despite nerve proximity. J Interv Card Electrophysiol 22, 23–30 (2008). https://doi.org/10.1007/s10840-008-9242-1

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  • DOI: https://doi.org/10.1007/s10840-008-9242-1

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