GASTROPARESIS SECONDARY TO PULMONARY VEIN CRYOABLATION: A FACTOR TO CONSIDER.

Mr. Editor: We present a patient underwent cryoballoon ablation for symptomatic atrial fibrillation with gastroparesis five days later. It was solved with conservative measures such as prokinetics. A 72-year-old woman with history of symptomatic paroxysmal atrial fibrillation treated with edoxaban. Pulmonary vein isolation, using a cryoballoon catheter, was performed. 5 days later she started with upper abdominal pain, bloating and vomiting. Computed tomography (CT) revealed marked gastric dilatation without any gastric or intestinal obstruction. Treatment with intravenous erythromycin was prescribed for 3 days and subsequently with oral cinitapride with good evolution. 10 days later, the disappearance of the findings with a stomach of normal dimensions without delay of gastric emptying is confirmed by esophagogastroduodenal transit. DISCUSSION Gastroparesis is an alteration characterized by a delayed gastric emptying in the absence of mechanical obstruction. It is usually manifested with postprandial fullness, belching and vomiting. The most frequent causes are: idiopathic, diabetes, Parkinson's, pharmacological and post-surgical (1). Cases of gastroparesis induced by ablation of the pulmonary veins have recently been described, which damages the periesophageal vagal plexus leading to gastric hypomotility (2,3). It is a rare but probably underdiagnosed complication because most patients remain asymptomatic. Additionally, the ablation with cryoballoon seems to increase the possibility of this collateral damage comparing to radiofrequency (2). Other risk factors associated to are: a small atrium, lower mean temperatures in the pulmonary vein and multiple applications (4). Radiology exams (radiography an CT scan) are normally enough to diagnose this entity. The diagnosis is made by radiography and CT. Although they are not able to quantify the delay of the gastric emptying they can appreciate the gastric dilatation and discard other causes. Confirmation by scintigraphy is not usually needed. In the cases described, the treatment used is prokinetic agents. Endoscopic treatment is saved for more severe patients (3). The new techniques of pulmonary ablation have increased the cases of symptomatic gastroparesis so it is important to recognize this trigger factor (2).