Prandial atrial fibrillation: off-pump pulmonary vein isolation with hiatal hernia repair.
Frequent palpitations with eating developed in a 62-year-old man with a history of typical gastroesophageal reflux successfully treated by Nissen fundoplication 5 years previously. A Holter monitor demonstrated paroxysmal atrial fibrillation associated with eating. Barium swallow showed a slipped Nissen fundoplication with herniation into the chest. Under a single anesthetic, the patient had median sternotomy and off-pump pulmonary vein isolation with a bipolar radiofrequency clamp and transabdominal redo-Nissen fundoplication. A 24-hour Holter monitor performed 6 weeks after operation demonstrated a normal sinus rhythm with no atrial fibrillation. Barium swallow demonstrated an intact infradiaphragmatic repair.
Gillinov
A Marc
AM
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gillinom@ccf.org
Rice
Thomas W
TW
D001281:Atrial Fibrillation / Q000209:etiology* / Q000601:surgery; D001466:Barium Sulfate; D003287:Contrast Media; D004435:Eating; D015716:Electrocardiography, Ambulatory; D016145:Endoscopy, Digestive System; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology; D006551:Hernia, Hiatal / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence
D003287:Contrast Media; D001466:Barium Sulfate