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Miyazaki S, Kobori A, Jo H, Keida T, Yoshitani K, Mukai M, Sagawa Y, Asakawa T, Sato E, Yamao K, Horie T, Manita M, Fukaya H, Hayashi H, Tanimoto K, Iwayama T, Chiba S, Sato A, Sekiguchi Y, Sugiura K, Iwai S, Isonaga Y, Miwa N, Kato N, Inaba O, Hirota T, Nagata Y, Ono Y, Hachiya H, Yamauchi Y, Goya M, Nitta J, Tada H, Sasano T. Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation. Front Cardiovasc Med 2023; 10:1278603. [PMID: 37965084 PMCID: PMC10642562 DOI: 10.3389/fcvm.2023.1278603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Background Symptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce. Objective We compared the clinical course of SGH occurring with different energy sources. Methods This multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation. Results The data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1-4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5-5) days; the total hospitalization duration was 11 [7-19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for >1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set. Conclusions The clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hikari Jo
- Department of Cardiology, National Hospital Organization Higashi-Hiroshima Medical Center, Hiroshima, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Kazuyasu Yoshitani
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Eiji Sato
- Department of Cardiovascular Medicine, Sendai City Hospital, Miyagi, Japan
| | - Kazuya Yamao
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Mamoru Manita
- Department of Cardiology, Naha City Hospital, Okinawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Suguru Chiba
- Department of Cardiology, Urasoe General Hospital, Okinawa, Japan
| | - Akinori Sato
- Cardiovascular Center, Tachikawa General Hospital, Niigata, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
| | - Shinsuke Iwai
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Yuhei Isonaga
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Naoyuki Miwa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Nobutaka Kato
- Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuichi Ono
- Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Grosse Meininghaus D, Freund R, Heimbaecher L, Kleemann T, Kushnir A, Geller JC. Incidence and clinical relevance of upper gastrointestinal pathology during preprocedural endoscopy in patients undergoing pulmonary vein isolation. Clin Res Cardiol 2022; 111:1069-1076. [PMID: 35716196 DOI: 10.1007/s00392-022-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Reflux-induced esophagitis might facilitate ablation-induced esophageal lesions (ELs) following pulmonary vein isolation (PVI), and these may progress to atrio-esophageal fistula (AEF). In contrast, preexisting ELs are not prone to progression but may affect procedure planning. OBJECTIVE To study the incidence of preexisting esophageal and upper gastrointestinal (UGI) pathology in patients undergoing PVI, and the relation to ablation-induced ELs. METHODS From 08/2018 to 09/2021, consecutive patients undergoing (radiofrequency [RF] or cryoballoon [CB]) PVI were examined by esophagogastroscopy (EGD) before and following ablation. Postprocedural endoscopic ultrasound (EUS) was added in 2021. RESULTS 412 patients (median age 67.5 [IQR 61.3-75.0] years, 56.1% male) were studied. Preprocedural EGD showed abnormalities in 226/399 patients, 15% in the lower third of the esophagus. Half (99/226) were relevant for PVI, 13 procedures were postponed, 6 due to pathological EGD results. A third of the patients with new esophageal injury following ablation had preexisting esophagitis which was associated with a trend for a higher incidence of ELs after RF ablation (12.5 vs. 6.9%, p = 0.232), and a six- and two-fold higher rate of food retention after CB-PVI (28.6 vs. 4.5%, p = 0.008) and RF ablation (8.3 vs. 4.4%, p = 0.279), respectively. CONCLUSION (1) EGD before PVI showed UGI abnormalities in > 50% of patients, one-fourth of these relevant for PVI. (2) Esophageal inflammation was associated with a higher incidence of post-ablation (peri)-esophageal injury. Whether having this information before ablation is able to reduce ELs or AEF remains to be shown.
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Affiliation(s)
- Dirk Grosse Meininghaus
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany.
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Lukas Heimbaecher
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Anton Kushnir
- Department of Radiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-Von-Guericke University School of Medicine, Magdeburg, Germany
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Cunningham CJ, Martínez JL. The Wandering Nerve: Positional Variations of the Cervical Vagus Nerve and Neurosurgical Implications. World Neurosurg 2021; 156:105-110. [PMID: 34587519 DOI: 10.1016/j.wneu.2021.09.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vagus ("wandering") nerve is the longest cranial nerve with the largest territory of innervation in the human body. Injury during various operative procedures involving the anterior or lateral neck may lead to serious complications. Per "textbook" descriptions, the cervical vagus nerve (CVN) commonly locates within the carotid sheath, in between the common carotid artery (CCA) and internal jugular vein (IJV). However, anatomic variations in its positioning may occur more often than expected and intraoperative identification may anticipate potential surgical pitfalls. METHODS A literature review was conducted per PRISMA guidelines for all studies describing positional variations of the CVN within the carotid sheath. A rare and potentially dangerous variation, occurring in only 0.7% of all reported cases, is illustrated with a cadaveric case. RESULTS Overall, 10 anatomic CVN variations have been described across 971 specimens. The non-textbook variations (26.5%) consist of: lateral (4.7%), anterolateral (8.7%), posteromedial (0.2%), posterior (5.8%), anterior (3.1%), medial (0.7%), and anteromedial (0.4%) to the CCA, as well as posterolateral (0.3%) and posterior (2.6%) to IJV. The "textbook" anatomic location is posterolateral to CCA (73.5%). Moreover, an increase in variability is reported on the left side (17.1%) compared with the right (11.3%). Our cadaveric dissection revealed a right-sided CVN directly medial to the CCA. CONCLUSIONS Positional variations of the CVN occur in over 26% of patients and may add difficulty to an array of surgical procedures. Knowledge of these variations and their prevalence may aid the surgeon in conducting a more precise dissection possibly preventing significant potential adverse sequelae.
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Affiliation(s)
- Coby J Cunningham
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jaime L Martínez
- Department of Neurologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
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Yamane T, Inaba O, Hachisuka E, Yamashita S, Yoshimura M, Nitta JI. Persistent diarrhea following catheter ablation for atrial fibrillation: A lesser-known complication of left atrial ablation procedures. HeartRhythm Case Rep 2021; 7:633-636. [PMID: 34552858 PMCID: PMC8441211 DOI: 10.1016/j.hrcr.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Eri Hachisuka
- Department of Social Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun-Ichi Nitta
- Department of Cardiology, Sakakibara Memorial Hospital, Tokyo, Japan
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Weber HP, Schaur P, Sagerer-Gerhardt M. Use of Light Sensor and Focused Local Atrial Electrogram Recordings for the Monitoring of Thermal Injury to the Esophagus and Lungs During Laser Catheter Ablation of the Posterior Atrial Walls: Preclinical In Vitro Porcine and In Vivo Canine Experimental Studies. J Innov Card Rhythm Manag 2019; 10:3723-3731. [PMID: 32477739 PMCID: PMC7252753 DOI: 10.19102/icrm.2019.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
During the catheter ablation of atrial fibrillation, thermal damages to the esophagus may have deleterious effects. The use of the SensoLas light sensor (SLLS; LasCor GmbH, Taufkirchen, Germany) and focused local atrial electrograms (LEGs) were tested as means for the assessment of thermal effects on the esophagus during laser catheter ablation. A total of 32 transcatheter in vitro and in vivo 1064-nm laser impacts were aimed at porcine (n = 16) and canine (n = 16) atrial endocardia. Photons scattering through the atrial and esophageal walls were captured by the SLLS, transmitted via an optical fiber to a diode, and converted to power displayed on a monitor. The laser was stopped automatically when the power measurement reached values beyond the preset upper limit. During in vivo laser applications, bipolar LEGs were recorded via the miniature electrodes of the laser catheter. Thermal damage to the esophagus was avoided when the power measurement was limited to 150 μW or less and the diode current was 60 μA or less, regardless of the energy setting used and regardless of the thicknesses of the atrial and esophageal walls. Laser energy applied for eight seconds to 13 seconds (average: 10 seconds) abolished the electrical potentials permanently. In conclusion, the control of laser light via the SLLS and of atrial potential amplitudes in the LEGs can prevent thermal esophageal and lung injury during laser catheter ablation.
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Affiliation(s)
- Helmut P. Weber
- Section of Research and Development, CCEP Centre Taufkirchen, Taufkirchen, Germany
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Sandler ML, Sims JR, Sinclair C, Sharif KF, Ho R, Yue LE, Téllez MJ, Ulkatan S, Khorsandi AS, Brandwein-Weber M, Urken ML. Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function. Head Neck 2019; 41:2450-2466. [PMID: 30957342 DOI: 10.1002/hed.25758] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. METHODS A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. RESULTS Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. CONCLUSION The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kayvon F Sharif
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | | | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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