TABLE 5.
Requirement of Pericardial Access for Phrenic Nerve Protection or Epicardial Ablation Along With the Complications Encountered
| First Author (Ref. #), Year | Ablation Limited by PN Proximity | Maneuvers to Avoid PN Injury | Pericardial Access | Endocardial RF Lesions* | Epicardial RF Lesions |
|---|---|---|---|---|---|
| Lee et al. (3), 1995 | NA | NA | NA | 3.6 ± 0.8 (SN modification ICE guided); 10.4 ± 2.1 (SN modification non–ICE guided) | NA |
| Callans et al. (5), 1999 | 0 | NA | NA | 16.4 ± 2.9 | NA |
| Man et al. (4), 2000 | NA | NA | NA | 22 ± 15 | NA |
| Marrouche et al. (16), 2002 | 2 (5.13%) | Lesions were delivered at sites showing capture of the PN (in 1 of them ablation induced diaphragm paralysis, which recovered 7 months later) | NA | 29 ± 11 | NA |
| Bonhomme et al. (13), 2003 | 1 (50%) | Open surgical procedure with repositioning of the PN | NA | NA | NA |
| Takemoto et al. (15), 2011 | NA | NA | NA | NA | NA |
| Frankel et al. (18), 2012 | 0 | NA | NA | NA | NA |
| Jacobson et al. (17), 2014 | 3 (60%) | Pericardial access. Two patients required injection of saline and air. In 2 patients, holding ventilation at end-expiration during RF applications | 5 (posterior) | 12.8 ± 7.8 | 22.4 ± 21.8 |
| Ibarra-Cortez et al. (14), 2015 | 12 (92.3%) | 10 patients required pericardial balloon insertion. In 2 patients, PN was avoided by holding ventilation | 4 (posterior), 6 (anterior) | 16 ± 4 | NA |
| Total | 18/102 (17.6%) | 15 (9.8%) | 20.01 ± 13.14 |