CTICasesPost-Ablation Phrenic Nerve Injury
Imaging findings
Serial chest radiographs show new, acute elevation and paralysis of the right hemidiaphragm, developing immediately following a catheter ablation procedure for atrial fibrillation. Cardiac MRI confirms the right hemidiaphragm elevation and adjacent pleural fluid, representing phrenic nerve injury.
Key takeaways
Phrenic nerve injury is a well-recognized but uncommon complication of catheter ablation (radiofrequency or cryoballoon) for atrial fibrillation, occurring in less than 1% of cases. It is caused by collateral thermal or electrical injury to the right phrenic nerve as it courses adjacent to the superior right pulmonary vein and SVC. Most cases resolve spontaneously over months, but some can be permanent.
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