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Catheter and Surgical Ablation of Atrial Fibrillation

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20 Vagal nerve injury Vagal nerve injury is defined as injury to the vagal nerve that results in esophageal dysmotility or gastroparesis. Vagal nerve injury is considered to be a major complication if it prolongs hospitalization, requires hospitalization, or results in ongoing symptoms for more than 30 days following an ablation procedure. Vascular access complication Vascular access complications include development of a hematoma, an AV fistula, or a pseudoaneurysm. A major vascular complication is defined as one which requires intervention such as surgical repair or transfusion, prolongs the hospital stay, or requires hospital admission. Table 7. Definitions of Complications Associated with AF Ablation (cont'd) Term Definition Table 8. Incidence, Prevention, Diagnosis, and Treatment of Selected Complications of AF Ablation Complication Incidence Selected prevention techniques Diagnostic testing Selected treatment options Air embolism <1% Sheath management Nothing or cardiac catheterization Supportive care with fluid, oxygen, head down tilt, hyperbaric oxygen Asymptomatic cerebral emboli (ACE) 2% to 15% Anticoagulation, catheter and sheath management, TEE Brain MRI None Atrialesophageal fistula 0.02% to 11% Reduce power, force, and RF time on posterior wall, monitor esophageal temp, use proton pump inhibitors; avoid energ y delivery over esophagus CT scan of chest, MRI, avoid endoscopy with air insufflation Surgical repair Treatment

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