Effect of Atrial Fibrillation Ablation on Gastric Motility

Abstract

Background-Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated. Methods and Results-We performed a prospective, observational study assessing the effect of atrial fibrillation ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study, and sham-feeding test (corresponding to esophageal, gastric, and small intestinal function evaluation, respectively) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 new abnormality on the UGI function tests (P<0.001). New onset esophageal dysmotility, delayed gastric emptying time, and abnormal sham-feeding tests were observed in 13 (48%), 13 (48%), and 9 (33%) patients, respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (P=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions-Atrial fibrillation ablation results in functional impairment of the UGI system, including the esophagus, stomach, and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

“…Many of these fibres travel left of the main trunks and innervate the fundus both anteriorly and posteriorly close to the sympathetic branches travelling in the gastrophrenic ligament35. Vagal nerve damage may lead to excessive relaxation of the fundus, hypomotility of the corpus and antrum, and desynchronization of gastric pacemaker activity, resulting in delayed gastric emptying39, 40, 41. In support of this hypothesis, the risk factors identified by univariable analysis in this study all share a common theme.…”

Vagus nerve injury symptoms after catheter ablation for atrial fibrillation

“…Our findings are supportive of those described by Lakkireddy et al., which examined gastric motility in 27 patients who underwent ablation. In this study, 33% of patients had abnormal gastric motility at baseline.…”

Upper gastrointestinal complications following ablation therapy for atrial fibrillation

“…28 In other studies, more definitive prospective observations were conducted at defined times before and after ablation therapy in a small number of subjects who underwent esophageal manometry, gastric emptying study, and responses to sham feeding test, corresponding to esophageal, gastric, and abdominal vagus evaluations. 29 We used electrocardiogram in the post-ablation period (immediate and delayed) to identify evidence of vagal dysfunction. Thus, the absence of sinus arrhythmia is suggestive of vagal dysfunction, 26 and we have evidence from follow-up that the vagal dysfunction was reversed in several patients, since sinus arrhythmia was re-established on follow-up evaluation.…”

“…29 It is presumed that tissue edema or microhematomas affecting the neighboring mediastinal structures during ablation therapy may have caused compression of the vagus nerve, resulting in injury. Therefore, the presence of vagal nerve injury could provide useful information about possible periesophageal injury that may predispose to esophageal fistula with an adjacent organ.…”