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. 2023 Oct 30:10:1278603.
doi: 10.3389/fcvm.2023.1278603. eCollection 2023.

Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation

Shinsuke Miyazaki  1 , Atsushi Kobori  2 , Hikari Jo  3 , Takehiko Keida  4 , Kazuyasu Yoshitani  5 , Moe Mukai  6 , Yuichiro Sagawa  7 , Tetsuya Asakawa  8 , Eiji Sato  9 , Kazuya Yamao  10 , Tomoki Horie  11 , Mamoru Manita  12 , Hidehira Fukaya  13 , Hidemori Hayashi  14 , Kojiro Tanimoto  15 , Tadateru Iwayama  16 , Suguru Chiba  17 , Akinori Sato  18 , Yukio Sekiguchi  19 , Kenta Sugiura  20 , Shinsuke Iwai  21 , Yuhei Isonaga  22 , Naoyuki Miwa  23 , Nobutaka Kato  21 , Osamu Inaba  22 , Takayoshi Hirota  20 , Yasutoshi Nagata  11 , Yuichi Ono  10 , Hitoshi Hachiya  23 , Yasuteru Yamauchi  7 , Masahiko Goya  1 , Junichi Nitta  19 , Hiroshi Tada  6 , Tetsuo Sasano  1
Affiliations

Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation

Shinsuke Miyazaki et al. Front Cardiovasc Med. .

Abstract

Background: Symptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce.

Objective: We compared the clinical course of SGH occurring with different energy sources.

Methods: This multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation.

Results: The data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1-4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5-5) days; the total hospitalization duration was 11 [7-19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for >1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set.

Conclusions: The clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%.

Keywords: atrial fibrillation; catheter ablation; complication; gastric hypomotility; pulmonary vein isolation; vagal nerve injury.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
The GH-related symptom improvement after AF ablation. GH, gastric hypomotility.
See this image and copyright information in PMC

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