228 Incidence of Gastroparesia After Pulmonary Vein Isolation With Cryoballoon Catheter in 25 Consecutive Patients Presenting Paroxystic or Permanent Atrial Fibrillation

Abstract

Various types of gastro-intestinal complications have already been reported after atrial fibrillation (AF) radiofrequency ablation. The objective of this prospective study was to assess the incidence of esogastric injuries after pulmonary vein isolation (PVI) with the cryoballoon catheter (Arctic Front, Cryocath, Quebec, Canada). Between December 2007 and April 2009, 25 patients (15 males, mean age 55 years old) with symptomatic, drug refractory, paroxysmal (n= 24) or persistent (n= 1) AF underwent circumferential antral PVI using a cryoballoon catheter. Post-procedural upper gastro-intestinal endoscopy was systematically performed on the following day. All procedures were performed in patients using a double lumen 23 or 28 mm cryoballoon catheter, with a mean maximal temperature of – 45.5 ± 19.7°C. Out of the 100 veins treated by the cryoballoon technique, 93 were completely isolated (93%). The number of balloon applications per vein was 2.2 ± 0.7 and the mean procedure time was 158.5 ± 28.7 minutes. Endoscopy found gastroparesia in 4 patients (16%, 2 gastric bezoar and 2 severe gastric stasis) which were considered as likely related to the ablation and due to vagal injury. All patients were asymptomatic. In 13 cases (52%), endoscopic abnormalities were considered as fortuitous (peptic gastritis and esophagitis, n=8; gastric ulcer, n=1; hiatal hernia, n=5; esophageal lipoma, n=1). In one case, the endoscopy revealed a Mallory Weiss syndrome, presumably connected to pre-operative trans-esophageal echocardiography. Esograstric endoscopy was normal in only 8 cases (32%). Cryoballoon catheter ablation for AF is associated with an unusual high incidence of gastroparesia (16%) which could be related to procedural periesophageal vagal nerve damage.