Abstract 10737: Incidence and Risk Factor of Acalculous Cholecystitis as a Complication of Catheter Ablation of Atrial Fibrillation Resulting From Vagus Nerve Injury
Background: Catheter ablation of atrial fibrillation (AF) may cause vagus nerve injury (VNI). It has been shown that peri-esophageal vagus nerve plexus affects kinetics of the gallbladder as well as the stomach. We recently experienced cases of acalculous cholecystitis following ablation of AF. We elucidated the incidence and predictors of VNI resulting in acalculous cholecystitis and gastric hypomotility.
Methods: We included 257 consecutive patients (194 male, 62 ±11 years) with symptomatic AF who underwent catheter ablation for either paroxysmal (N= 164) or persistent AF (N= 93). Extensive encircling pulmonary vein isolation with stepwise approach was performed under deep sedation with propofol. The ablation settings at the left atrial (LA) posterior wall were a maximum energy of 30 W and a maximum duration of 40 seconds using 3.5 or 4 mm open-irrigated catheter under esophageal temperature monitoring (upper limit 39- 42°C).
Results: VNI occurred in 5 (1.9 %) patients within 3 days after ablation; 3 patients developed gastric hypomotility and 2 developed acalculous cholecystitis. When these 5 patients were compared with the remaining 252 patients without VNI, VNI patients had a wider transverse LA-esophageal contact (26.1 ± 7 vs. 19.5 ± 5 mm, p= 0.035), a shorter distance of esophagus to spine (4.6 ± 1 vs. 7.1 ± 3 mm, p= 0.051) and longer procedure time (299 ± 12 vs. 234 ± 72 min., p= 0.009). All patients recovered completely within 1 to 4 weeks. One patient with cholecystitis required percutaneous transhepatic gallbladder drainage (figure), and the other was cured by antimicrobial therapy. Three patients with gastric hypomotility recovered with conservative treatment.
Conclusion: Not only gastric hypomotility but also acalculous cholecystitis may develop as a result of peri-esophageal VNI in a small portion of patients undergoing catheter ablation of AF. A wider LA-esophagical contact width and longer procedure time may be predictors for VNI.
- © 2013 by American Heart Association, Inc.