Gastric Hypomotility After Luminal Esophageal Temperature Guided Second-Generation Cryoballoon Pulmonary Vein Isolation

Hasegawa, Kanae; Miyazaki, Shinsuke; Hisazaki, Kaori; Kaseno, Kenichi; Amaya, Naoki; Shiomi, Yuichiro; Takahashi, Naoto; Ikeda, Hiroyuki; Fukuoka, Yoshitomo; Morishita, Tetsuji; Ishida, Kentaro; Uzui, Hiroyasu; Tada, Hiroshi

doi:10.1161/circep.118.006691

Cited by 9 publications

(15 citation statements)

References 5 publications

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“…Hasegawa et al reported that AGP after PVI with cryoballoon frequently occurred in cases where the esophagus was located between the left and right inferior PV ostia, which is equivalent to the middle‐positioned esophagus in our study. This result is consistent with ours 20 . Moreover, esophageal contraction can be observed during catheter ablation 21,22 .…”

Section: Discussionsupporting

confidence: 92%

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Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

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Background Catheter ablation for atrial fibrillation is an effective treatment; however, periesophageal vagal nerve injury is not rare and sometimes results in acute gastroparesis (AGP) after atrial fibrillation ablation (AFA). We sought to investigate the incidence and risk factors of AGP via preprocedural computed tomography (CT) analysis. Methods We retrospectively reviewed 422 patients who underwent index AFA at our center. Using contrast‐enhanced CT performed before ablation, the anatomical characteristics of the esophagus were compared between patients with and without post‐ablation AGP. AGP was diagnosed by the presence of symptoms, fasting abdominal X‐ray radiography as a screening test, and additional abdominal imaging. Results Of the 422 patients (age, 67 ± 11 years; male, 68.5%; cryoballoon, 63.7%), AGP developed in 14 (3.3%) patients, and six of 14 patients were asymptomatic. AGP resolved in all patients within 4 weeks without invasive treatment. In the AGP group, the esophagus was frequently located on the vertebra (middle‐positioned esophagus) (AGP vs non‐AGP, 42.9% vs 11.5%; P = .01), and additional posterior wall ablation was frequently performed (50.0% vs 14.5%; P = .02). In the multivariate analysis, middle‐positioned esophagus (P = .02; odds ratio, 9.0; 95% confidence interval [CI], 1.5‐53.3) and additional posterior wall ablation (P = .01; odds ratio, 7.6; 95% CI, 1.5‐42.1) were independent predictors of AGP. Conclusions Anatomical evaluation of the esophagus using CT may be simple and useful for predicting AGP after AFA. High‐risk patients who have middle‐positioned esophagus or who underwent excessive posterior wall ablation should be followed up closely.

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Section: Discussionsupporting

confidence: 92%

“…This result is consistent with ours. 20 Moreover, esophageal contraction can be observed during catheter ablation. 21 , 22 We speculate that this phenomenon may not occur sufficiently in the case of a middle‐sided esophagus.…”

Section: Discussionmentioning

confidence: 99%

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

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“…Another study showed that 3% (n=3) of patients exhibited symptomatic gastric hypomotility despite cryoapplication being terminated when the LOT reached 25°C. [39] The symptoms (abdominal bloating and repeated vomiting) manifested 2–5 days post-procedure, after the stomach had time to be filled with food, and abdominal imaging demonstrated marked gastric dilatation with retained food. After fasting for 4–5 days and treatment with panthenol, metoclopramide, and erythromycin, the symptoms were gone and imaging findings showed a complete recovery 7–11 days post-procedure.…”

Section: Gastric Hypomotilitymentioning

confidence: 99%

Complications of Cryoballoon Pulmonary Vein Isolation

Miyazaki

Tada

2019

Arrhythm Electrophysiol Rev

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Since the cryoballoon (CB) was introduced into clinical practice, more than 400,000 patients have undergone a pulmonary vein (PV) isolation with a CB throughout the world. Although the efficacy of the first-generation CB was limited, the recently introduced secondgeneration CB has achieved a greater uniformity in cooling, which has facilitated a shorter time to PV isolation, shorter procedural times, higher rates of freedom from atrial fibrillation and low rates of PV reconnections. Currently, a single short freeze strategy with a single 28 mm balloon has become the standard technique based on the balance of procedural efficacy and safety. However, enhanced cooling characteristics may also result in a greater potential for collateral damage to non-cardiac structures. Knowledge about the potential complications is essential when performing the procedure. In this article, we describe the important complications that should be noted during a CB procedure, and how to minimise the risk of complications based on our experience.

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“…Hasegawa et al 8 reported that the incidence of symptomatic GH after CBA for PVI was 3.0%; however, as the degree of symptoms associated with GH may be slight in some cases, the incidence of symptomatic GH may be underestimated.…”

Section: Gh After Ablationmentioning

confidence: 99%

“…CT, computed tomography; LA, left atrial; LAPW, left atrial posterior wall [Color figure can be viewed at wileyonlinelibrary.com] function (e.g., discomfort, abdominal pain, nausea, and bloating). [5][6][7][8] However, there are no available data regarding GH after CBA of the LA roof. Therefore, we aimed to investigate GH after CBA of the LA roof, as well as factors that may be related to the occurrence of GH.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of gastric hypomotility after additional cryoballoon ablation of the left atrial roof

Shigeta

Yamauchi

Oda

et al. 2021

Pacing Clinical Electrophis

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Introduction: Gastric hypomotility (GH) is a major complication of atrial fibrillation (AF) ablation. We aimed to clarify whether additional cryoballoon ablation (CBA) of the left atrial (LA) roof is associated with GH. Methods and Results:This study included 54 patients with non-paroxysmal AF who underwent CBA for pulmonary vein isolation and of the LA roof line. GH was defined according to the results of esophagogastroscopy performed 2 days after ablation. GH was observed in 10 patients. There were significant differences in LA diameter (LAD), right inferior pulmonary vein (RIPV) diameter, and the height of the LA roof from the point where the LA posterior wall and esophagus make contact between patients with (GH+) and without GH (GH-) (LAD: 41.

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Gastric Hypomotility After Luminal Esophageal Temperature Guided Second-Generation Cryoballoon Pulmonary Vein Isolation

Cited by 9 publications

References 5 publications

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Complications of Cryoballoon Pulmonary Vein Isolation

Prevalence of gastric hypomotility after additional cryoballoon ablation of the left atrial roof

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