Shinya Yamada1, Takashi Kaneshiro2,3, Naoko Hijioka2, Kazuaki Amami2, Yukiko Horikoshi4, Yukio Yamadera4, Takuto Hikichi5, Akiomi Yoshihisa2, Yasuchika Takeishi2. 1. Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. smyyamada0124@yahoo.co.jp. 2. Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. 3. Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan. 4. Department of Clinical Laboratory, Fukushima Medical University, Fukushima, Japan. 5. Department of Endoscopy, Fukushima Medical University, Fukushima, Japan.
Abstract
PURPOSE: Clinical significance of reduced vagal activity following pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unclear. Periesophageal vagal nerve injury following PVI may be a powerful contributing factor of decreased vagal tone. METHODS: Drug-refractory 51 AF patients (31 males, 64 ± 11 years), who underwent successful PVI, were enrolled. We performed esophagogastroduodenoscopy 2 days after PVI and assessed delayed gastric emptying (DGE). Additionally, the coefficient of variance of R-R interval (CVRR) as a surrogate for vagal tone was measured before PVI, as well as at 1 day and 3 months after PVI. The patients were divided into two groups, patients with DGE and patients without DGE, and changes in CVRR were compared. RESULTS: After PVI, 12 out of 51 patients (23.5%) had DGE. The baseline CVRR did not differ between the patients with (n = 12) and those without (n = 39) DGE (median 3.13%, interquartile range 1.69-5.13 vs. median 3.76%, interquartile range 2.96-5.90, P = 0.297). However, CVRR at 1 day after PVI was significantly lower in the patients with DGE than in those without (median 1.49%, interquartile range 0.90-2.19 vs. median 2.59%, interquartile range 1.58-3.86, P = 0.035), and then CVRR at 3 months became similar between the two groups, suggesting that the two groups had different changes in vagal tone after PVI. The recurrence of AF was similar at 3-6 months after PVI between the two groups. CONCLUSIONS: A significantly decreased CVRR immediately after PVI is a sign of DGE incidence, implying collateral damage to the esophagus.
PURPOSE: Clinical significance of reduced vagal activity following pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unclear. Periesophageal vagal nerve injury following PVI may be a powerful contributing factor of decreased vagal tone. METHODS: Drug-refractory 51 AFpatients (31 males, 64 ± 11 years), who underwent successful PVI, were enrolled. We performed esophagogastroduodenoscopy 2 days after PVI and assessed delayed gastric emptying (DGE). Additionally, the coefficient of variance of R-R interval (CVRR) as a surrogate for vagal tone was measured before PVI, as well as at 1 day and 3 months after PVI. The patients were divided into two groups, patients with DGE and patients without DGE, and changes in CVRR were compared. RESULTS: After PVI, 12 out of 51 patients (23.5%) had DGE. The baseline CVRR did not differ between the patients with (n = 12) and those without (n = 39) DGE (median 3.13%, interquartile range 1.69-5.13 vs. median 3.76%, interquartile range 2.96-5.90, P = 0.297). However, CVRR at 1 day after PVI was significantly lower in the patients with DGE than in those without (median 1.49%, interquartile range 0.90-2.19 vs. median 2.59%, interquartile range 1.58-3.86, P = 0.035), and then CVRR at 3 months became similar between the two groups, suggesting that the two groups had different changes in vagal tone after PVI. The recurrence of AF was similar at 3-6 months after PVI between the two groups. CONCLUSIONS: A significantly decreased CVRR immediately after PVI is a sign of DGE incidence, implying collateral damage to the esophagus.
Entities:
Keywords:
Atrial fibrillation; Coefficient of variance of R-R interval; Delayed gastric emptying; Pulmonary vein isolation
Authors: Moloy Das; Jonathan J Loveday; Gareth J Wynn; Sean Gomes; Yawer Saeed; Laura J Bonnett; Johan E P Waktare; Derick M Todd; Mark C S Hall; Richard L Snowdon; Simon Modi; Dhiraj Gupta Journal: Europace Date: 2017-05-01 Impact factor: 5.214