Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study.

AIMS: High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning. METHODS AND RESULTS: A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032). CONCLUSION: The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review.

BACKGROUND: Vagus nerve injury (VNI) is a feared complication of antireflux surgery (ARS). The impact of VNI on the functional outcomes of ARS has not yet been evaluated systematically. The aim of this review was to evaluate the impact of VNI on functional and clinical outcome of ARS. METHODS: A systematic search was performed until March 2015, using the following online databases: MEDLINE, Embase and the Cochrane Register of Controlled Clinical Trials. Eight studies remained available for assessment. Articles were divided into 2 groups: (a) one with unintended, accidental VNI and (b) one group comparing ARS with and without intended vagotomy. RESULTS: The prevalence of unintended, accidental VNI ranged from 10 to 42% after ARS. No clear differences were seen in outcome for reflux control between the VNI and vagus nerve intact group. A higher prevalence of diarrhea, nausea and vomiting was observed in the VNI group. CONCLUSION: VNI is a feared but neglected complication of ARS. Larger prospective studies that objectively assess vagus nerve integrity before and after ARS are needed.

National prevalence and impact of perioperative vagus nerve injury in vestibular schwannoma.

OBJECTIVES/HYPOTHESIS: Lower cranial nerve injury may be an under-reported complication of vestibular schwannoma surgery. This study aims to characterize the prevalence of complications associated with vagus nerve injury following vestibular schwannoma surgery and the impact of these complications on patient care. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Discharge data from the Nationwide Inpatient Sample for 17,281 patients with vestibular schwannoma who underwent surgery in 2003-2008 were analyzed using cross-tabulations and multivariate regression modeling. RESULTS: Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs. CONCLUSIONS: Although infrequently reported in this national inpatient sample, vagus nerve injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.