We Evaluated CT-guided Localization of the Right Phrenic Nerve to Enhance Safety in Transcatheter Ablation
Conditions
Keywords
Right Phrenic Nerve, Phrenic Nerve Localization, Computed Tomography, CT-Guided Imaging, Radiofrequency Ablation, Catheter Ablation, Transcatheter Ablation Safety, Cardiac Ablation Complications, Ablation Procedures, Phrenic Nerve Injury
Brief summary
The anatomical location of the right phrenic nerve (RPN) in close proximity to the right pulmonary veins has become a critical consideration for electrophysiologists performing pulmonary vein isolation, the cornerstone treatment for atrial fibrillation. Although radiofrequency ablation in this region is rarely associated with complications-unlike cryoballoon ablation-the proximity of the RPN to the ablation site is considered the most widely accepted mechanism of nerve injury. Therefore, accurately defining its anatomical course is essential to prevent complications. This concern extends to any ablation procedure performed near the RPN, including those targeting the lateral-posterior region of the right atrium, particularly during atrial tachycardia ablation or cardioneuroablation. Several methods have been used to precisely localize the RPN. The most commonly employed technique is phrenic nerve stimulation; however, there is growing interest in the use of computed tomography (CT) to identify structures running parallel to the nerve-such as the pericardiophrenic artery and vein-enhanced with contrast. Three-dimensional reconstruction through image segmentation has proven useful in defining the anatomy of cardiac chambers and adjacent extracardiac structures. This study aims to compare two approaches for visualizing the course of the right phrenic nerve: one based on computed tomography imaging and the other on the nerve's response to stimulation during the procedure. This comparison will allow us to assess the concordance between imaging findings and intra-procedural observations, ultimately contributing to improved procedural safety.
Interventions
None listed
Sponsors
Centro Medico Teknon
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Ability to provide informed consent * Patients who have undergone or will undergo transcatheter AF ablation or CNA * Availability of 64-slice contrast-enhanced MDCT with RPN segmentation using ADAS® software prior to ablation * Age ≥ 18 years
Exclusion criteria
* Inability to provide informed consent * Inability to perform contrast-enhanced CT before transcatheter AF ablation or CNA * Age \< 18 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| analyse the anatomy of the RPN | From January 2021 to April 2025 | The primary endpoint of this study is to analyse the anatomy of the RPN using three-dimensional (3D) imaging and iso-distance mapping with ADAS® software, and to validate its accuracy through traditional pace mapping. |
| Accuracy of Imaging-Guided Anatomical Localization of the Phrenic Nerve with ADAS® software Compared With Conventional Pacemapping | from the procedure to 12 months later | The positions as observed by the 2 different methods are compared and the correlation was expressed as a percentage. Global image correlation is computed as the mean correlation between methods. |
Countries
Spain
Outcome results
None listed