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Autonomic cardiogastric neural interaction after pulmonary vein isolation in patients with atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

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Acknowledgements

We thank Ms. Kasumi Ouchi (Office for Gender Equality Support, Fukushima Medical University, Fukushima, Japan) as well as Mr. Shuuya Endou for their outstanding technical assistance.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Shinya Yamada, Takashi Kaneshiro, Naoko Hijioka, Kazuaki Amami, Akiomi Yoshihisa & Yasuchika Takeishi

  2. Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan

    Takashi Kaneshiro

  3. Department of Clinical Laboratory, Fukushima Medical University, Fukushima, Japan

    Yukiko Horikoshi & Yukio Yamadera

  4. Department of Endoscopy, Fukushima Medical University, Fukushima, Japan

    Takuto Hikichi

Authors
  1. Shinya Yamada
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  2. Takashi Kaneshiro
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  3. Naoko Hijioka
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  4. Kazuaki Amami
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  7. Takuto Hikichi
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  8. Akiomi Yoshihisa
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  9. Yasuchika Takeishi
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Correspondence to Shinya Yamada.

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Ethical approval

The study protocol was approved by the ethics committee of Fukushima Medical University (approval number: 1808).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Yamada, S., Kaneshiro, T., Hijioka, N. et al. Autonomic cardiogastric neural interaction after pulmonary vein isolation in patients with atrial fibrillation. J Interv Card Electrophysiol 65, 357–364 (2022). https://doi.org/10.1007/s10840-021-01004-z

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  • DOI: https://doi.org/10.1007/s10840-021-01004-z

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