ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2023
Optimal prevention method of phrenic nerve injury in superior vena cava isolation: efficacy of high-power, short-duration radiofrequency energy application on the risk points.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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10 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Usefulness of empiric superior vena cava isolation in paroxysmal atrial fibrillation ablation: a meta-analysis of randomized clinical trials.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Pooled it
- Pulmonary vein isolation with or without empiric superior vena cava isolation in patients undergoing ablation for paroxysmal atrial fibrillation: the randomized ESVCI-AF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Trial
- [Late complications after atrial fibrillation ablation : Diagnosis and management].Herzschrittmachertherapie & Elektrophysiologie · 2026Review
- Feasibility and safety of a novel very-high-power short-duration ablation strategy for superior vena cava isolation.Heart rhythm O2 · 2026Article
- High-power short-duration ablation of the superior vena cava: safety and efficacy using the right superior pulmonary vein roof as a landmark.BMC cardiovascular disorders · 2025Article
- Superior Vena Cava as an Arrhythmogenic Substrate in Atrial Fibrillation: Anatomical, Electrophysiological and Clinical Perspectives.Journal of clinical medicine · 2025Review
- Feasibility, Acute Efficacy and Safety of Empirical Superior Vena Cava Isolation in Addition to Pulmonary Vein Isolation Using the Fourth-Generation Cryoballoon: Insights from a Randomized Trial.Journal of clinical medicine · 2025Article
- Feasibility of a 90-watt, 3-second radiofrequency application for superior vena cava isolation during atrial fibrillation ablation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Phrenic nerve injury after atrial fibrillation ablation: different recovery courses among cryoballoon, laser balloon, and radiofrequency ablation.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- High-Power Short-Duration Ablation of Paroxysmal and Persistent Atrial Fibrillation.Reviews in cardiovascular medicine · 2023Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background or purposeSuperior vena cava isolation (SVCI) is widely performed adjunctively to atrial fibrillation (AF) ablation. Right phrenic nerve injury (PNI) is a complication of this procedure. The purpose of the study is to determine the optimal PNI prevention method in SVCI.
methodsA total of 1656 patients who underwent SVCI between 2009 and 2022 were retrospectively examined. PNI was diagnosed based on the diaphragm position and movement in the upright position on chest radiographs before and after SVCI.
resultsWith the introduction of various PN monitoring systems over the years, the incidence of SVCI-associated PNI has decreased. However, complete PNI avoidance has not been achieved. PNI incidence according to fluoroscopy-guided PN monitoring, high-output pace-guided, compound motor action potential-guided, and 3-dimensional electro-anatomical mapping (EAM) systems was 8.1% (38/467), 2.7% (13/476), 2.4% (4/130), and 2.8% (11/389), respectively. However, a high-power, short-duration (50 W/7 s) radiofrequency (RF) energy application only on PNI risk points tagged by a 3-dimensional EAM system completely avoids PNI (0%; 0 /160 since April 2021). PNI showed no symptoms and recovered within an average of 188 days post-SVCI, except for a few patients who required > 1 year.
conclusionsAlthough PNI incidence decreased annually with the introduction of various monitoring systems, these monitoring systems did not prevent PNI completely. Most notably, the delivery of a high-power, short-duration RF energy only on risk points tagged by EAM prevented PNI completely. PNI recovered in all patients. The application of higher-power, shorter-duration RF energy on risk points tagged by EAM appears to be an optimal PNI prevention maneuver.
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