Phrenic paralysis during cardiac electronic device implantation: incidence, causes and clinical course

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Phrenic paralysis is a known complication of central venous catheterization, but it is not listed as a complication related to cardiac implantable electronic device (CIED) implants. The aim of this study is to describe the incidence, causes, clinical picture, and management of phrenic paralysis occurring in this scenario.

Methods and results

We retrospectively analysed data from our CIED implantation database and identified those patients who suffered phrenic paralysis during the implantation procedure. Four of 891 patients (subclavian puncture in 626) developed phrenic paralysis during pacemaker or defibrillator implant procedures. Severe respiratory failure needing ventilatory support occurred in two, being the phrenic paralysis transient in all of the cases.


Transient phrenic paralysis may occur during CIED implantation probably related to the infiltration of local anaesthesia in the subclavian area. Mechanism, prevention, and management are discussed.

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