title: Effect of atrial fibrillation ablation on gastric motility: the atrial fibrillation gut study.
abstract: BACKGROUND
  Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated.
  
  
  RESULTS
  We performed a prospective, observational study assessing the effect of atrial fibrillation 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) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (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 UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 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
  Atrial fibrillation 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.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center. dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Johnson
authors.initials: J
authors.lastname: Rajasingh
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Reginald
authors.initials: R
authors.lastname: Dusing
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Rhea
authors.initials: R
authors.lastname: Pimentel
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: From the Cardiovascular Research Institute (D.L., Y.M.R., D.A., J.R., A.K., R.P., S.B., B.D.), Division of Gastroenterology (M.O.), Department of Radiology (R.D.), University of Kansas Hospital & Medical Center.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004947:Esophagus / Q000294:innervation*; D005260:Female; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D018589:Gastroparesis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007421:Intestine, Small / Q000294:innervation*; D007615:Kansas; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000294:innervation*; D013997:Time Factors; D016896:Treatment Outcome; D061223:Vagus Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: atrial fibrillation; catheter ablation; vagus nerve