title: Factors associated with periesophageal vagal nerve injury after pulmonary vein antrum isolation.
abstract: BACKGROUND
  Periesophageal vagal nerve injury is recognized as a rare complication in atrial fibrillation ablation procedures. We investigated the factors associated with the occurrence of symptomatic periesophageal vagal nerve injury after pulmonary vein antrum isolation.
  
  
  RESULTS
  Overall, 535 consecutive patients who underwent sole pulmonary vein antrum isolation were included. Point-by-point radiofrequency applications were applied using irrigated-tip catheters under minimal sedation without esophageal temperature monitoring. In the initial 165 patients, the ablation settings for the posterior left atrium were a maximum energy of 25 to 30 W and a duration of 30 seconds. In the subsequent 370 patients, the power was additionally limited to 20 to 25 W at specific parts of the posterior left atrium where the ablation line transversed the esophagus. Symptomatic gastric hypomotility was found in 13 patients, and all were observed during the initial period (7.9%). No other collateral damage was observed. Logistic regression analysis revealed that the body mass index was the only independent predictor for identifying patients with gastric hypomotility (odds ratio 0.770; 95% confidence interval 0.643 to 0.922; P=0.0045) during the initial period. The prevalence of gastric hypomotility was significantly higher in the initial study period than subsequently (0 of 370, 0%; P<0.0001). All except for 1 patient recovered completely with conservative treatment within 4 months after the procedure.
  
  
  CONCLUSIONS
  Periesophageal vagal nerve injury is more common collateral damage than direct esophageal injury in pulmonary vein antrum isolation procedures. Titrating the radiofrequency energy at specific areas where the ablation line transverses the esophagus and taking account of the body mass index might reduce occurrences not only of direct esophageal damage but also of periesophageal vagal nerve injury in pulmonary vein antrum isolation procedures.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusa
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Noboru
authors.initials: N
authors.lastname: Ichihara
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Jin
authors.initials: J
authors.lastname: Iwasawa
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan (K.H.).
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan (S.M., H.T., S.K., Y.K., N.I., T.T., J.I., A.K., H.N., H.H., Y.I.).
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000379:methods; D004947:Esophagus / Q000293:injuries* / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D061223:Vagus Nerve Injuries / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
keywords: atrial fibrillation; catheter ablation; collateral damage; complication; periesophageal vagal nerve injury; pulmonary vein isolation