Esophageal acid levels after pulmonary vein isolation for atrial fibrillation.

BACKGROUND

Pulmonary vein antrum isolation (PVAI) is a potentially curative, nonpharmacologic treatment of atrial fibrillation (AF). Several procedural complications have been described, including esophageal wall lesions ranging from erythema and esophagitis, necrosis and ulcer, to atrio-esophageal fistula. We prospectively studied changes in esophageal acid levels before and after PVAI.

METHODS

We performed 24-hour pH-metry before and 1.3 +/- 1.6 days after PVAI, in 25 patients (mean age = 62 +/- 12 years, 17 men) with symptomatic AF. A 2-mm transnasal probe was inserted into the inferior part of the esophagus and into the stomach to measure pH levels at fixed intervals. DeMeester scores, indicating acidic gastro-esophageal reflux, were calculated.

RESULTS

The mean number of reflux episodes increased from 89 +/- 80 before to 107 +/- 94 after PVAI. The mean percentage of time with esophageal pH < 4 was shorter after (108 +/- 193 minutes) than before PVAI (159 +/- 245 minutes). The mean DeMeester score decreased from 49 +/- 68 before to 31 +/- 41 after PVAI (P < 0.05). We observed erythema or esophagitis in five patients, necrosis or ulcer in seven, and atrio-esophageal fistula in no patient.

CONCLUSIONS

Our hypothesis of increased acid levels caused by stimulation of the right vagal nerve during isolation of the right upper pulmonary vein was not verified.