Abstract 5679: Are Esophageal Acid Levels Acutely Affected By Pulmonary Vein Antrum Isolation In Patients With Atrial Fibrillation?
Introduction: Atrial fibrillation (AF) is a common arrhythmia associated with increased morbidity and mortality. Pulmonary vein antrum isolation (PVAI) has gained a tremendous interest since being recognized as a potential curative non-pharmacologic treatment of restoring sinus rhythm. Several complications of this procedure were described and included endoscopic findings of the esophageal wall, which ranged from erythema/esophagitis or necrosis/ulcer to atrio-esophageal fistula. We prospectively studied changes of the esophageal acid level pre and post PVAI.
Methods and results: In 25 patients (17 men, 62 ± 12 years) with symptomatic AF, a 24-hour pH-metry was performed before (pre) and 1,3±1,6 days post PVAI. Therefore, a 2 mm probe was inserted through the nasal cavity down to the inferior part of the esophagus and the stomach to register pH-levels at defined intervals. The mean number of reflux episodes increased from 89±80 pre to 107±94 post PVAI. The mean percentage of time with esophageal pH<4 was lower post PVAI (108±193 min) as compared to pre PVAI (159±245 min). The DeMeester Score, indicating acidic gastroesophageal reflux in patients with esophageal symptoms in the absence of endoscopically visible lesions, significantly decreased from 49±68 pre PVAI to 31±41 post PVAI (p<0.05). There were 5 patients with erythema/esophagitis, 7 patients with necrosis/ulcer, but no patient with atrio-esophageal fistula.
Conclusion: Although there were endoscopic findings of esophageal wall changes, we could not prove an increase in esophageal acid levels post PVAI. The hypothesis of increased acid levels caused by stimulation of the right vagal nerve during isolation of the right upper pulmonary vein could not be confirmed. Therefore, AF itself might have an impact on higher esophageal acid levels in patients undergoing PVAI.