Intentional pneumothorax avoids collateral damage: Dynamic phrenic nerve mobilization through intrathoracic insufflation of carbon dioxide

摘要

Ventricular-overdrive pacing during clinical tachycardia with (1) V-A-A-V response and (2) distinct atrial activation sequences and P-wave morphologies between clinical tachycardia and pacing. Activation mapping during clinical tachycardia with (1) denoting earliest activation, (2) denoting locations of phrenic nerve capture, and (3) denoting ineffective cryoablation lesions and denoting cryoablation lesion that resulted in temporary dampening of diaphragmatic excursion. Attempted phrenic nerve displacement through percutaneous subxyphoid pericardial instrumentation with (1) an 8.5 French steerable sheath and a steerable catheter, (2) placeholder J wire for a second pericardial access, and (3) endovascular 4 mm mapping/ablation catheter, duodecapolar catheter (DD) for phrenic nerve pacing, and decapolar coronary sinus catheter (CS). d = distal; HIS = His bundle catheter; m = mid; p = proximal; RVA = right ventricular apex catheter.