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

Abstract

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 obser...