Imaging of Pericardiophrenic Bundles Using Multislice Spiral Computed Tomography for Phrenic Nerve Anatomy

Phrenic nerve injury and diaphragmatic stimulation are common complications following arrhythmia ablation and pacing therapies. Preoperative comprehension of phrenic nerve anatomy via non-invasive CT imaging may help to minimize the electrophysiological procedure-related complications.

Coronary CT angiography data of 121 consecutive patients were collected. Imaging of left and right pericardiophrenic bundles was performed with volume rendering and multi-planar reformation techniques. The shortest spatial distances between phrenic nerves and key electrophysiology-related structures were determined. The frequencies of the shortest distances ≤5 mm, >5 mm and direct contact between phrenic nerves and adjacent structures were calculated.

Left and right pericardiophrenic bundles were identified in 86.8% and 51.2% of the patients, respectively. The right phrenic nerve was <5 mm from right superior and inferior pulmonary veins in 92.0% and 3.2% of the patients, respectively. The percentage of right phrenic nerve, <5 mm from right atrium, superior caval vein, and superior caval vein-right atrium junction was 87.1%, 100%, and 62.9%, respectively. Left phrenic nerve was <5 mm from left atrial appendage, great cardiac vein, anterior and posterior interventricular veins, and left ventricular posterior veins in 81.9%, 1.0%, 39.1%, 28.6%, and 91.4% of the patients, respectively. Merely 0.06% left phrenic nerve had a distance <5 mm with left superior pulmonary vein, and none left phrenic nerve showed a distance <5 mm with left inferior pulmonary vein.

One-stop enhanced CT scanning enabled detection of phrenic nerve anatomy, which might facilitate avoidance of the phrenic nerve-related complications in interventional electrophysiology.