Cardiac catheter ablation, including radiofrequency ablation (RFA), is the treatment of choice for recurrent refractory cardiac arrhythmias. A rare complication of cardiac ablation is right phrenic nerve damage leading to ipsilateral diaphragmatic paralysis. Patients can be asymptomatic, dyspneic, or have respiratory failure. Here we present a case of a patient with symptomatic diaphragmatic paralysis that resolved after weight loss from a laparoscopic sleeve gastrectomy (LSG). Discuss the details of this unique case and explore the possible pathophysiology of this phenomenon.
A 65-year-old woman underwent elective RFA for refractory atrial fibrillation. Shortly following the procedure, she developed dyspnea and right diaphragmatic paralysis from iatrogenic phrenic nerve injury. One year later, she underwent a LSG despite continued dyspnea on exertion and diaphragmatic paralysis evidence on Sniff test.
Three months after postoperatively, the patient had lost 13.5kg and had resolution of her respiratory symptoms. Repeat chest x-ray showed normal right hemi-diaphragm positioning. One other case report showed improvement in respiratory function with a 19kg weight loss in a patient with bilateral diaphragmatic paralysis. To our knowledge, this is the first case in which bariatric surgery may have played a role in recovery of iatrogenic unilateral diaphragmatic paralysis.
Most cases of paralyzed diaphragm after cardiac catheter ablation have resolution one year after ablation. Our patient continued to have symptoms and imaging consistent with diaphragmatic paralysis until after she underwent LSG. Weight loss from the bariatric surgery may have aided in the resolution of her diaphragmatic paralysis.