Key result
PVI linked to vagal nerve injury in ~32% of patients regardless of energy source.
Why the study?
Damage to (peri)-esophageal tissue after PVI has not decreased and its pathophysiology is incompletely understood, with vagal nerve injury potentially involved in progression to atrio-esophageal fistula.
Does pulmonary vein isolation cause vagal nerve injury and gastric motility disorders in patients with atrial fibrillation?
Cohort (n=85)
Does pulmonary vein isolation cause vagal nerve injury and gastric motility disorders in patients with atrial fibrillation?
Pulmonary vein isolation frequently induces vagal nerve injury independent of the energy source, which is associated with postprocedural endoscopic pathologies and may contribute to esophageal lesion progression.
Vagal injury after PVI warrants vigilance for motility disorders; extends observations but leaves open preventive strategies.
INTRODUCTION: Safety of pulmonary vein isolation (PVI) has been established in clinical studies. However, despite prevention efforts the incidence of damage to (peri)-esophageal tissue has not decreased, and the pathophysiology is incompletely understood. Damage to vagal nerve branches may be involved in lesion progression to atrio-esophageal fistula. Using electrogastrography, we assessed the incidence of periesophageal vagal nerve injury (VNI) following atrial fibrillation ablation and its association with procedural parameters and endoscopic results. METHODS: Patients were studied using electrogastrography, endoscopy, and endoscopic ultrasound before and after cryoballoon (CB) or radiofrequency (RF) PVI. The incidence of ablation-induced neuropathic pattern (indicating VNI) in pre- and postprocedural electrogastrography was assessed and correlated with endoscopic results and ablation data. RESULTS: Between February 2021 und January 2022, 85 patients (67 ± 10 years, 53% male) were included, 33 were treated with CB and 52 with RF (38 with moderate power moderate duration [25-30 W] and 14 with high power short duration [50 W]). Ablation-induced VNI was detected in 27/85 patients independent of the energy form. Patients with VNI more frequently had postprocedural endoscopically detected pathology (8% mucosal esophageal lesions, 36% periesophageal edema, 33% food retention) but there was incomplete overlap. Pre-existing esophagitis increased the likelihood of VNI. Ablation data and esophageal temperature data did not predict VNI. CONCLUSION: PVI-induced VNI is quite common and independent of ablation energy source. VNI is part of (peri)-esophageal damage and only partially overlaps with endoscopic findings. VNI-associated acidic reflux may be involved in the complex pathophysiology of esophageal lesion progression to fistula.
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Meininghaus et al. (2023) conducted a cohort in Atrial fibrillation (n=85). Pulmonary vein isolation (cryoballoon or radiofrequency) was evaluated on Ablation-induced vagal nerve injury (VNI) detected by electrogastrography. Pulmonary vein isolation induced vagal nerve injury in 31.8% (27/85) of patients, independent of whether cryoballoon or radiofrequency energy was used.
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