CTICasesRight Phrenic Nerve Injury and Hemidiaphragm Paresis post Left Atrial Cryoablation
Imaging findings
Sequential chest radiographs show progressive, marked elevation of the right hemidiaphragm following a left atrial catheter ablation procedure. On lateral view, the elevation is complete, extending all the way posteriorly. Over several months, follow-up radiographs document a gradual return of the right hemidiaphragm to its normal anatomical height.
Key takeaways
Right phrenic nerve injury is a well-known, transient complication of catheter ablation (including cryoablation) for atrial fibrillation, occurring due to the nerve's close anatomical course along the right superior pulmonary vein and lateral right atrium. The injury is typically a neuropraxia resulting from thermal or cryo-energy exposure, causing diaphragmatic paresis or paralysis. Most cases resolve spontaneously within several months as the nerve recovers.
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