The Effect of Atrial Fibrillation Ablation on Gastric Motility "The AF Gut Study"

Background —Collateral damage to the vagal nerve and the upper gastro-intestinal (UGI) system during AF ablation has not been systematically evaluated. Methods and Results —We performed a prospective, observational study assessing the impact of AF ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study and sham feeding test (corresponding to esophageal, gastric and small intestinal function evaluation respectively) prior to ablation (baseline) and subsequently at 24 hours, 90 days and 180 days after the procedure. In addition, UGI symptom assessment using PAGI-SYM® questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal upper gastrointestinal (UGI) function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours following the RFA, 20 (74%) patients had at least one new abnormality on the UGI function tests (p<0.001). New onset esophageal dysmotility, delayed gastric emptying time and abnormal sham feeding tests were observed in 13 (48%), 13 (48%) and 9 (33%) patients respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (p=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions —AF ablation results in functional impairment of the UGI system including the esophagus, stomach and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration —http://clinicaltrials.gov; Unique Identifier: [NCT01396356][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01396356&atom=%2Fcircae%2Fearly%2F2015%2F03%2F14%2FCIRCEP.114.002508.atom