Additional posterior wall isolation is associated with gastric hypomotility in catheter ablation of atrial fibrillation

Oikawa, Jun; Fukaya, Hidehira; Wada, Takuya; Horiguchi, Akio; Kishihara, Jun; Satoh, Akira; Saito, Daiki; Sato, Tetsuro; Matsuura, Gen; Arakawa, Yuki; Kobayashi, Shuhei; Yuki, Satoshi; Nishinarita, Ryo; Ishizue, Naruya; Katada, Chikatoshi; Tanabe, Satoshi; Niwano, Shinichi; Ako, Junya

doi:10.1016/j.ijcard.2020.10.069

Cited by 14 publications

(20 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We speculate that the periesophageal vagal nerve was likely to be injured when the esophagus was compressed between the LA and the vertebrae. Moreover, additional posterior wall isolation with PVI was reported to be a risk factor for AGP 19 . To prevent AGP, additional linear lesions near the esophagus should be avoided.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

Background Catheter ablation for atrial fibrillation is an effective treatment; however, periesophageal vagal nerve injury is not rare and sometimes results in acute gastroparesis (AGP) after atrial fibrillation ablation (AFA). We sought to investigate the incidence and risk factors of AGP via preprocedural computed tomography (CT) analysis. Methods We retrospectively reviewed 422 patients who underwent index AFA at our center. Using contrast‐enhanced CT performed before ablation, the anatomical characteristics of the esophagus were compared between patients with and without post‐ablation AGP. AGP was diagnosed by the presence of symptoms, fasting abdominal X‐ray radiography as a screening test, and additional abdominal imaging. Results Of the 422 patients (age, 67 ± 11 years; male, 68.5%; cryoballoon, 63.7%), AGP developed in 14 (3.3%) patients, and six of 14 patients were asymptomatic. AGP resolved in all patients within 4 weeks without invasive treatment. In the AGP group, the esophagus was frequently located on the vertebra (middle‐positioned esophagus) (AGP vs non‐AGP, 42.9% vs 11.5%; P = .01), and additional posterior wall ablation was frequently performed (50.0% vs 14.5%; P = .02). In the multivariate analysis, middle‐positioned esophagus (P = .02; odds ratio, 9.0; 95% confidence interval [CI], 1.5‐53.3) and additional posterior wall ablation (P = .01; odds ratio, 7.6; 95% CI, 1.5‐42.1) were independent predictors of AGP. Conclusions Anatomical evaluation of the esophagus using CT may be simple and useful for predicting AGP after AFA. High‐risk patients who have middle‐positioned esophagus or who underwent excessive posterior wall ablation should be followed up closely.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Moreover, additional posterior wall isolation with PVI was reported to be a risk factor for AGP. 19 To prevent AGP, additional linear lesions near the esophagus should be avoided. Even in CBA cases, Aksu et al reported that a lower temperature in the lower PVs during CBA was a risk factor for AGP.…”

Section: Discussionmentioning

confidence: 99%

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

show abstract

“…This is likely related to injury to the esophageal plexus. One study demonstrated gastric hypomotility, defined as gastric contents observed during esophagogastroduodenoscopy despite 12 h fast, was significantly more common among patients who underwent PVI with PWI compared to PVI alone (54.8% vs. 18.2%, p = .002) 46 . However, only 8% of patients were symptomatic and all symptoms resolved within a month.…”

Section: Anatomic Considerations Impacting Safety and Efficacy Of Pwimentioning

confidence: 99%

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Clarke

Piccini

Friedman

2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

The left atrial posterior wall has many embryologic, anatomic, and electrophysiologic characteristics, that are important for the initiation and maintenance of persistent atrial fibrillation. The left atrial posterior wall is a potential target for ablation in patients with persistent atrial fibrillation, a population in whom pulmonary vein isolation alone has resulted in unsatisfactory recurrence rates. Published clinical studies report conflicting results on the safety and efficacy of posterior wall isolation. Emerging technologies including optimized use of radiofrequency ablation, pulse field ablation, and combined endocardial/epicardial ablation may optimize approaches to posterior wall isolation and reduce the risk of injury to nearby structures such as the esophagus. Critical evaluation of future and ongoing clinical studies of posterior wall isolation requires careful scrutiny of many characteristics, including intraprocedural definition of posterior wall isolation, concomitant extrapulmonary vein ablation, and study endpoints.

show abstract

Section: Introductionmentioning

confidence: 99%

“…The free walls (including the posterior wall) are typically the thinnest portion of the left atrium. 1 While this makes lesion transmurality more achievable, it also increases the risk of complications related to excess energy delivery, including pericarditis, vagal injury (gastric and esophageal hypomotility), 2 atrioesophageal fistula, 3 and perforation. Owing to increasing interest in posterior wall isolation as a strategy for reducing recurrent atrial fibrillation (AF) in the setting of nonparoxysmal AF, 4 , 5 , 6 optimal energy titration is essential for maximizing safety and efficacy.…”

Section: Introductionmentioning

confidence: 99%

Continuous and discontinuous radiofrequency energy delivery on the atrial free wall: Lesion transmurality, width, and biophysical characteristics

et al. 2021

View full text Add to dashboard Cite

Background Although lesion transmurality is required for durable pulmonary vein isolation, excess ablation is associated with increased risk of complications. Objective We sought to understand the impact of interrupted radiofrequency (RF) delivery conditions on lesion characteristics in the atrial free wall. Methods Thirty-three (11 left atrial, 22 right atrial) RF ablation lesions were created in the atria of 6 swine using power control mode (25 W, target contact force 15 g) with 1 of 3 conditions: 15 seconds ablation (n = 8), 30 seconds ablation (n = 14), or 2 15-second ablations at the same site separated by a 2-minute interruption (15 seconds × 2) (n = 11). Results Thirty of 33 lesions were transmural. Rates of transmurality ( P = .45) and endocardial lesion width (5.6 ± 1.2 mm, P = .70) were similar between conditions. Mean tissue thickness was 1.7 ± 0.8 mm for transmural lesions. Wide variability in bipolar electrogram attenuation was observed across and within conditions and there were no significant between-group differences. Although impedance reductions were numerically greater in the 30-second and 15-second × 2 conditions (-14.6 ± 6.6 ohms and -14.0 ± 4.4 ohms, respectively) compared to the 15-second condition (-10.3 ± 6.4 ohms), variability was large, and differences were not statistically significant ( P = .243). Impedance changes after ablation were largely transient. Conclusion A single 15-second ablation at 25 W (target contact force of 15 g) with good stability produced similarly sized lesions compared to 30-second ablations and 2 15-second ablations at the same site in atrial free wall tissue. These data suggest over-ablation in the atria is common, larger-diameter lesions may require greater power, and many clinically available parameters of lesion size may be unreliable on the posterior wall.

show abstract

Additional posterior wall isolation is associated with gastric hypomotility in catheter ablation of atrial fibrillation

Cited by 14 publications

References 19 publications

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Continuous and discontinuous radiofrequency energy delivery on the atrial free wall: Lesion transmurality, width, and biophysical characteristics

Contact Info

Product

Resources

About