title: Evaluation of periesophageal nerve injury after pulmonary vein isolation using the (13)C-acetate breath test.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) has become an important option for treating patients with atrial fibrillation (AF). Periesophageal nerve (PEN) injury after PVI causes pyloric spasms and gastric hypomotility. This study aimed to clarify the impact of PVI on gastric motility and assess the prevalence of gastric hypomotility after PVI.
  
  
  METHODS
  Thirty consecutive patients with AF underwent PVI under luminal esophageal temperature (LET) monitoring. The (13)C-acetate breath test was conducted before and after the procedure for all patients (PVI group). Gastric emptying was evaluated using the time to peak concentration of (13)CO2 (T max). This test was also conducted in another 20 patients who underwent catheter ablation procedures other than PVI (control group).
  
  
  RESULTS
  The number of patients with abnormal T max (≥75 min) increased from seven (23%) to 13 (43%) and from three (15%) to five (25%) after the procedure in the PVI group and control group, respectively. The mean T max was longer after PVI than before PVI (64±14 min vs. 57±15 min, p=0.006), whereas there was no significant difference before and after the procedure in the control group. However, no significant difference in ΔT max was observed between the two groups (p=0.27). No patients suffered from symptomatic gastric hypomotility.
  
  
  CONCLUSIONS
  Asymptomatic gastric hypomotility occurred more often after PVI. However, the average impact of PVI on gastric motility was minimal.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kanaeda
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Marehiko
authors.initials: M
authors.lastname: Ueda
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishimura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Kajiyama
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Hashiguchi
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Hiranuma
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Oyamada
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
keywords: 13C-acetate breath test; Atrial fibrillation; Gastric emptying; Periesophageal nerve; Pulmonary vein isolation