Collateral Nervous Damages After Cryoballoon Pulmonary Vein Isolation

Guiot, Aurélie; Savouré, Arnaud; Godin, B.; Anselme, Frédéric

doi:10.1111/j.1540-8167.2011.02219.x

Cited by 70 publications

(49 citation statements)

References 45 publications

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“…Consequently, most electrophysiologists have not paid attention to this complication, in contrast to direct esophageal injury. This can occur not only with RF energy delivery but also with cryothermal energy delivery …”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Periesophageal Vagal Nerve Injury After Pulmonary Vein Antrum Isolation

Miyazaki

Taniguchi

Kusa

et al. 2014

JAHA

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BackgroundPeriesophageal 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.Methods and ResultsOverall, 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.ConclusionsPeriesophageal 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.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Periesophageal Vagal Nerve Injury After Pulmonary Vein Antrum Isolation

Miyazaki

Taniguchi

Kusa

et al. 2014

JAHA

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“…462,1075,1188,1189 Permanent PN palsy resulting from CBA is far less common, with an incidence of 0.3% in the recently completed FIRE AND ICE trial. 490 PN palsy has also been reported with the laser-balloon ablation system.…”

Section: Section 10: Complicationsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,762

1,468

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“…1,7,9,10 Prior to this study, the pathologic mechanism underlying cold-induced nervous injury, and subsequent potential for recovery, remained unclear. 1,7,9,10 Prior to this study, the pathologic mechanism underlying cold-induced nervous injury, and subsequent potential for recovery, remained unclear.…”

Section: Pathologic Characterization Of Phrenic Nerve Injurymentioning

confidence: 99%

Histopathology of Cryoballoon Ablation‐Induced Phrenic Nerve Injury

Andrade

Dubuc

Ferreira

et al. 2013

Cardiovasc electrophysiol

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Collateral Nervous Damages After Cryoballoon Pulmonary Vein Isolation

Abstract: Gastroparesis and PNP could be observed in a significant number of cases after cryoballoon ablation of AF. These complications are likely due to cryo-induced damages to nervous structures surrounding the heart.

Cited by 70 publications

References 45 publications

Factors Associated With Periesophageal Vagal Nerve Injury After Pulmonary Vein Antrum Isolation

Factors Associated With Periesophageal Vagal Nerve Injury After Pulmonary Vein Antrum Isolation

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Histopathology of Cryoballoon Ablation‐Induced Phrenic Nerve Injury

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