Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited "Jackhammer Esophagus": A New Complication Due to Vagal Nerve Stimulation?

Journal of Neurogastroenterology and Motility
Salvatore ToloneLudovico Docimo

Abstract

Radiofrequency catheter ablation (RFCA) is a potentially curative method for treatment of highly symptomatic and drug-refractory atrial fibrillation (AF). However, this technique can provoke esophageal and nerve lesion, due to thermal injury. To our knowledge, there have been no reported cases of a newly described motor disorder, the Jackhammer esophagus (JE) after RFCA, independently of GERD. We report a case of JE diagnosed by high-resolution manometry (HRM), in whom esophageal symptoms developed 2 weeks after RFCA, in absence of objective evidence of GERD. A 65-year-old male with highly symptomatic, drug-refractory paroxysmal AF was candidate to complete electrical pulmonary vein isolation with RFCA. Prior the procedure, the patient underwent HRM and impedance-pH to rule out GERD or hiatal hernia presence. All HRM parameters, according to Chicago classification, were within normal limits. No significant gastroesophageal reflux was documented at impedance pH monitoring. Patient underwent RFCA with electrical disconnection of pulmonary vein. After two weeks, patient started to complain of dysphagia for solids, with acute chest-pain. The patient repeated HRM and impedance-pH monitoring 8 weeks after RFCA. HRM showed in all liqu...Continue Reading

References

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Citations

Jul 23, 2016·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·Edoardo SavarinoRoberto Penagini
Jul 17, 2019·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·Farhan QuaderC Prakash Gyawali
Apr 3, 2020·Journal of Neurogastroenterology and Motility·Matthew WooChristopher N Andrews
Apr 4, 2019·Canadian Journal of Gastroenterology & Hepatology·Marianne ClémentMickael Bouin
Jun 3, 2020·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·Benjamin AnonLaurence Picon
Oct 13, 2020·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·Edoardo Savarino, André J P M Smout
Dec 19, 2020·Journal of Clinical Gastroenterology·Sami R AchemRonnie Fass

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Methods Mentioned

BETA
X-ray

Software Mentioned

Sandhill Bioview

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