-Original-

Anatomical Factors Associated with Periesophageal Vagus Nerve Injury after Catheter Ablation of Atrial Fibrillation

Ippei Tsuboi, Meiso Hayashi, Yasushi Miyauchi, Yu-ki Iwasaki, Kenji Yodogawa, Hiroshi Hayashi, Shunsuke Uetake, Kenta Takahashi and Wataru Shimizu

Department of Cardiovascular Medicine, Nippon Medical School

Background: The periesophageal vagus nerve plexus controls the kinetics of the stomach, digestive tract, and gallbladder, and catheter ablation of atrial fibrillation (AF) can cause vagus nerve injury (VNI). We sought to clarify the incidence, clinical course, and anatomical factors related to periesophageal VNI.
Methods: The present study included 257 consecutive patients with AF (mean age, 62±11 years) who underwent catheter-based pulmonary vein isolation. With 64-slice computed tomographic images, the left atrium (LA)-esophageal contact length, LA diameter, and distances between each mediastinal structure were compared between patients with VNI and those without VNI.
Results: VNI occurred in 5 patients (1.9%), gastric hypomotility in 3 patients, and acalculous cholecystitis in 2 patients, within 3 days after ablation, and all patients recovered completely within 2 weeks. Compared with patients without VNI, those with VNI more frequently underwent ablation at the mitral isthmus (p=0.03) and inside the coronary sinus (p=0.03). On computed tomographic images, the esophagus was closer to the aorta than to the spine in 67% of patients and was defined as an aorta-sided esophagus. In patients with VNI, the distance from the LA to the spine or the descending aorta (in patients with an aorta-sided esophagus) was shorter (p=0.03), and the transverse LA-esophageal contact length was longer (p=0.01).
Conclusion: Acalculous cholecystitis, as well as gastric hypomotility, can develop as a result of periesophageal VNI in patients undergoing AF ablation. The anatomical relationships among the LA, esophagus, spine, and descending aorta may influence the occurrence of VNI.

J Nippon Med Sch 2014; 81: 248-257

Keywords
vagus nerve injury, gastric hypomotility, acalculous cholecystitis, atrial fibrillation, catheter ablation

Correspondence to
Meiso Hayashi, MD, Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
m-h4510@nms.ac.jp

Received, December 13, 2013
Accepted, January 6, 2014