Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation

BackgroundSymptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce.ObjectiveWe compared the clinical course of SGH occurring with different energy sources.MethodsThis multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation.ResultsThe 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.ConclusionsThe 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%

Prognostic Impact of Renal Dysfunction Does Not Differ According to the Clinical Profiles of Patients: Insight from the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry

<div><p>Background</p><p>Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation.</p><p>Methods and Results</p><p>ADHF syndromes registry subjects were evaluated (N = 4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8%) patients aged 73.3±13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95% confidence interval 1.75–3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104–0.924, and was always >0.05).</p><p>Conclusions</p><p>Baseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.</p></div

Relationship between the baseline estimated glomerular filtration rates and in-hospital mortality.

<p>eGFR, estimated glomerular filtration rate.</p

All-cause mortality in different patient subgroups.

<p>Abbreviation; eGFR, estimated glomerular filtration rate; mBP, mean blood pressure; PPP, proportional pulse pressure; JVP, juglur venous distension; BNP, brain natriuretic peptide; LVEF, left ventricular ejection fraction.</p><p>All-cause mortality in different patient subgroups.</p

The prognostic impact of renal dysfunction in the prediction of all-cause mortality in relation to the underlying etiologic mechanisms.

<p>LVEF, left ventricular ejection fraction; mBP, mean blood pressure; PPP, proportional pulse pressure; JVD, jugular venous distension; BNP, brain natriuretic peptide.</p

Management of patients with and without renal dysfunction.

<p>Data are expressed as mean ± standard deviation (SD), as number (percentage), or as median (interquartile range).</p><p>eGFR, estimated glomerular filtration rate; NIPPV, non-invasive positive-pressure ventilation; ACE-I, angiotensin-converting-enzyme inhibitor; ARB, angiotensin II receptor blocker.</p><p>Management of patients with and without renal dysfunction.</p

Distribution of estimated glomerular filtration rates levels on admission to hospital.

<p>GFR, glomerular filtration rate</p

Evaluation of the receiver operating characteristic curve for renal dysfunction.

<p>The area under the curve was 0.63 (95% confidence interval = 0.61–0.64, p<0.001), and the cut-off value for the greatest sensitivity and specificity was 50.25 mL/min/1.73 m². GFR, glomerular filtration rate; CI, confidence interval; ROC, receiver operating characteristic.</p