Epicardial Sinus Node Modification Using 5% Dextrose Insulation to Prevent Phrenic Nerve Injury: A Case Report

This case illustrates the feasibility of using D5W as an epicardial insulating medium to facilitate sinus node modification in close proximity to the phrenic nerve. While effective phrenic nerve protection was achieved, the occurrence of pericardial complications underscores the need for cautious patient selection, meticulous procedural technique, and further evaluation of safety strategies when employing non-physiologic insulating solutions in the epicardial space.