Phrenic nerve injury

In September I had a heart ablation. I continued to have labored breathing after the ablation. After six weeks of going through this my cardiologist Took an x-ray and compared it to the one before the ablation. He sent me to the hospital to have a CT scan done. He told me that the results show My right diaphragm is paralyzed. This is what's causing my labored breathing. This was due to the electrophysiologist injuring my phrenic nerve during the ablation. Needless to say, I am not happy with the results. He is wanting me to continue this breathing for six more months to see if it will heal on its own. If it doesn't, he is going to insert a diaphragm pacemaker. I just want to know if anyone has ever had to go through such a procedure and what the final results were. Thanks so much

32 Replies

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  • Hello PZiglar, I'm not medically qualified, but I understand that damage to the phrenic nerve is not uncommon with ablation. It is true that very often, it does heal on it's own without any intervention. Not overly helpful I know, but hopefully your situation will improve in time, best wishes, John

  • Thanks John, I appreciate your response. I am trying to be patient, I was just so excited to have the ablation done so my life could go back to feeling a little bit closer to normal. But now just hope that the nerve heals on its own. Thanks again.

  • HI, PZiglar, see below what I found on an AFib patient follow up site called 'The Patient after Atrial Fibrillation'. I think in your case it sounds quite positive as you didn't need mechanical ventilation as it stipulates in the paragraph below so yours might be the transient case that they talk about. Try to relax and not worry for the next few weeks and it might get better on its own. Best Wishes. Trish

    Phrenic nerve injury: this rare (<0,5%) but sometimes dramatic complication can occur when ablating the right superior PV (close to right phrenic nerve) or within the LA appendage (close to left phrenic nerve) [26,27]. Symptoms vary broadly from asymptomatic to severe dyspnea leading to respiratory insufficiency that requires temporary mechanical ventilation support. Although it is usualy transient, in some patients can be permanent.

  • I often wonder what is not told us before these quite serious procedures... I can think of a few that have happened to me and those close to mel.Theproblem is have to be super knowledgeable to know what to ask.

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    Touche

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  • It is mentioned as a rare complication in the AFA literature on ablation and it was clearly explained to me in hospital before signing the consent forms.

  • Hi Trish, appreciate the fast response. I will try to relax, was hoping that after ablation I would be over all this. Since February, have had 3 cardioversions, heart cath and then the ablation. Not a good year. Was hoping the new year would be better but having to wait another 5 months to see if nerve heals. I always say though that things could be worse. Thanks for the information and the immediate response. Take care.

  • I agree with what has been said above- I have heard many EPs and cardiologists say that damage to the phrenic nerve does happen but usually recovers so do try to be positive- let us know how you get on

  • Thanks Rosy, I am trying to remain positive. Will keep you updated.

  • I was told that "very serious complications" occur in about 2-4% of ablations. They include stroke, damage to the phrenic nerve, damage to the heart wall, damage to the food pipe, and a few other problems. If your situation is not too serious then it sounds like you are lucky. it could have been much worse. Best wishes that it heals on its own.

  • Thanks so much for your response. I was told this was not common by the cardiologist, my response was that's how my luck goes. Hopefully, it heals on its own. I'm just not a patient person. Lol. But I really don't have any other choice right now. Thanks again for your response.

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    you should kno some good lawyers;

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    and the perp of your injury should be dealt w/.

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  • I disagree, inevitably there will be some complications in some people - I really hope we don't go further down the way of the US and the blame culture resulting in huge legal compensation claims which is already draining our NHS of services. I would prefer a clear compensation procedure for those unfortunates who suffer from poor practice.

    I think that we should adopt a learn not blame culture where professionals are able to own mistakes and learn from each other's to improve.

    There is nothing to indicate that a mistake has been made in this case by the way.

  • My cardiologist told me that the electrophysiologist made the mistake of getting too close to the wall of the heart which caused the injury to the phrenic nerve. These were his words. As you can see in my earlier response to IC4miles that I have never been a person to sue but whenI think about how this ablation should have ended on a good note, I get angry plus the fact that I have to sleep in a recliner sitting up and have to sit down because I am so out of breath just from mopping or vacuuming floors. Doctor says to try to avoid crowds because I am more susceptible to pneumonia. So all this has upset my life, my husband and my family but I am trying to remain positive. Thanks for your response.

  • I understand that and I am so sorry for you situation and in no way would minimise how it has affected you, it must be very difficult.

    All of these procedures carry a risk and having had 2 ablations this risk was very clearly explained to me and it was explained that the tolerances between burning too much and damaging the nerve too little and the ablation being ineffective is less than 1 mm and does depend upon the skill of the EP but even the best on not always on top form 100% of the time.

    Both my ablations took over 6 hours and were quite eventful, I came around to find a nurse jumping up and down on my chest as the catheter had caught something and my heart stopped, which was the point at which EP decided best to stop whilst ahead.

    It would be difficult not to be angry and very disappointed about the effect on your quality and I do wish you well and a speedy recovery.

  • Thanks so much for your information. That had to be really horrible to wake up and see the nurse jumping on your chest, I do wish you well.

  • I have thought about that but I have never been that type of person. Always felt that was why our insurance premiums go up but still thinking about it. Everyone else keeps asking me about that also. Thanks for your response.

  • I think that is why I believe there should be some sort of compensation scheme, unless there was negligence.

  • Hi, I had exactly the same complication after my ablation last November. As I was recovering after the procedure, I was struggling to take a breath in- it was very scary. I told the doctors and had an echo scan to check for bleeding around the heart, but everything was OK there. I was sent home and told not to worry. Two days later I was admitted to hospital with pneumonia ( a possible complication of phrenic nerve damage, as the lungs can't fully expand), so the breathing problem was put down to pneumonia.. After this I had laboured breathing for weeks. I saw the cardiologist and asked to see a respiratory specialist, who, like in your case, compared X-rays and noticed the raised diaphragm and realised that the phrenic nerve was damaged. I was told there was nothing to be done but wait- up to a year- for it to repair itself. It has now been a year. My breathing has improved quite a lot, so I am hopeful the nerve has repaired, and I am getting my life back and building up my strength and fitness little by little. I am due to see the cardiologist and have another X-ray in January, and hope they find my diaphragm is ok. It has been a long haul, but there is light at the end of the tunnel for me I think.

    I think it is very worrying that there are potentially many people who have phrenic nerve damage after ablation that is just not diagnosed. It was only through my own perseverance and persistence, asking to see a respiratory specialist,that I got a diagnosis. It makes me wonder just how rare it really is if diagnoses aren't made!

    The good thing for you is that it has been diagnosed.My advice to you is breathe as deeply as you can manage, keep as mobile and take regular gentle exercise as much you can, and try not to worry too much just yet. It is early days for you in your recovery. My reading has shown me that most phrenic nerve damage does repair - it just takes time, usually around a year. I wish you well in your recovery.

  • Thank you Tessybear for a positive response. I, like you pushed the issue of the labored breathing to my cardiologist. That is when he compared x-rays. After the ablation I followed up with the electrophysiologist and he said not to worry about the breathing, it will taper off. I also said that his nurse said my oxygen level was low, his response was it will get better with time. He told me that I did not need to come back to his office just to continue following with cardiologist. I heard after I had a CTscan, my doctor called him and told him what happened. Thanks again for your response. Nice to know there might be a light at the end of this tunnel.

  • Must be very disappointing for you, certainly your Annus Horriblis.

    I haven't had that complication but I didn't recover from ablation as expected, one unrelated to ablation, but I do relate to the disappointment.

    Wishing you a full and healthy recovery however long it takes.

  • Can we know who the EP was and/or where it was done? This would be valuable knowledge for those deciding where to get ablations done.

  • Past performance isn't definitive for future performance.

  • Yes but an ablation is an extremely difficult operation. In my view only a few EPs have got all the skills to get it right. EP is a relatively new discipline and I think there are quite a number, if not the majority, who do not have the right skills.

    It is possible that an EP can make a serious mistake on the phrenic nerve, learn from that and go on to be an excellent EP in a few years time. In the meantime I would use caution however.

  • You can research the experience of an EP yourself and you can always ask them - I did and found that both the EPs I have dealt with were very open and honest and approachable. I think it is very sensible to enquire about their experience and their success rates before deciding who to allow into your heart - literally!

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    remarkably forgiving.

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    then there's the issue of you apparently not being informd of this poss complication.

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    my m.o. is to question docs before procedures on their education and experience, ie, How many of these procedures do you do in a month; have many have you done? where were you educated?

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    my state has more foreign-educated docs than any other;

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    they can command lower compensation than docs educated @ Harvard, Yale...

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    and the system needs to...."economize."

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    a prob in UK, too I understand :

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    bbc.com/news/uk-england-man... May 2015.

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    ‘The chief prosecutor in the UK Stepping Hill double-murder case

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    raises the "extremely worrying" prospect

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    ‘that many untrained foreign workers could be working in UK hospitals…’

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    *** Fake diplomas ***

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    “On one street in Manila, BBC’s investigators found evidence that

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    “any document or diploma can be forged for a price.

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    “Nursing degrees are particularly popular and as little as £20 can buy a qualification.

    “One forger, who wanted to remain anonymous, told BBC News:

    " ‘Lots of requests to make a diploma in nursing. On average per month 35 people are asking for that. It costs 1,500 pesos (about £22 / $34).’ “

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  • Let us not get too political - this is a health forum not a political one.

    As formerly stated above - I agree that it is common sense to ask about training and experience before agreeing to any procedure unfortunately too many people feel too intimidated to enquire or are still of the belief that because they are a medical professional they know better.

    Both doctor and patient have an obligation to agree a working alliance, in my opinion.

    There are fraudsters and con artists everywhere but employers also have a responsibility to ensure that all references are properly researched and confirmed before employing an applicant. I know after several cases where this wasn't done the procedures have been strengthened in many organisations.

  • the intimidation of patients doesnt happen by accident,

    not to be too political, but think class war, who'r the casualties?

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  • Hello, I am sorry to hear that you are going through this. I had my second ablation done on 11/9. My electrophysiologist said the area he is probably going to ablate is close to my phrenic nerve but he said he would use techniques like tilting me on the table a little and if needed push the Phrenic nerve via balloon through pericardial access to avoid injury to phrenic nerve. But luckily he ablated just by tilting me on table a little and avoided phrenic nerve. He also told me before the procedure that if phrenic nerve injured I will have breathing issues and phrenic nerve injury will heal on its own and it takes atleast 6 to 12 months. I would say it is better to get a second opinion before going for diaphragmatic pacemaker. Hope everything works for you.

  • I wish my doctor had been more informative as far as injuries. His last words to me were he is an excellent doctor and I have no need to worry. My cardiologist informed him (the EP) of his injury to my phrenic nerve. Have not heard from him.

  • The lawyers just love doctors who undertake the management of high risk procedures as they can look forward to a good income from them and the hospitals they work in. However if we want to receive these procedures, surely we have to accept some responsibilty for our own care and known complications

  • I think one needs to ask how often the EP has had serious complications in their work and also the numbers of ablations they carry out- don't go to a centre without high volumes of ablations as those have had the worst results.

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