Aksu Tolga, Golcuk Sukriye, Guler Tumer E, Yalin Kıvanç, Erden Ismail
Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey.
Department of Cardiology, Faculty of Medicine, Koc University, Istanbul, Turkey.
Am J Cardiol. 2015 Jul 1;116(1):92-7. doi: 10.1016/j.amjcard.2015.03.045. Epub 2015 Apr 8.
Percutaneous catheter ablation is a safe and effective treatment for symptomatic drug-resistant atrial fibrillation (AF). Gastroparesis is a little known complication of AF ablation. We aimed to evaluate the frequency of gastroparesis in the patients who underwent catheter ablation for AF by cryoballoon (CB) or radiofrequency (RF) and to define risk factors for gastroparesis. In all, 104 patients were treated with pulmonary vein (PV) isolation with 2 different technologies: CB in 58 patients (group 1) and open-irrigated tip RF catheter in 46 patients (group 2). Gastroparesis was seen in 7 cases (6 cases in group 1 and 1 case in group 2, respectively). The complaints related with gastroparesis began during the procedure in 4 of 6 patients of group 1. The other 3 patients admitted to our outpatient clinic with similar complaints within 72 to 96 hours after the procedure. For gastroparesis cases of group 1, mean minimal CB temperature on inferior PVs was lower and left atrium diameter was smaller. Management was conservative, and the patients have no residual symptoms at 6-month follow-up. The only patient still demonstrating residual symptoms during follow-up was in group 2. Although, clinically manifest gastroparesis is quite common with CB ablation, the process is generally reversible. However, damage may not be as reversible with RF ablation. In conclusion, during cryoablation, lower temperatures on inferior PVs and small left atrium size may be associated with increased risk of gastroparesis, and fluoroscopic guidance may be useful to avoid this complication.
经皮导管消融术是治疗有症状的药物难治性心房颤动（AF）的一种安全有效的方法。胃轻瘫是AF消融术鲜为人知的一种并发症。我们旨在评估接受冷冻球囊（CB）或射频（RF）导管消融治疗AF的患者中胃轻瘫的发生率，并确定胃轻瘫的危险因素。共有104例患者采用两种不同技术进行肺静脉（PV）隔离：58例患者采用CB（第1组），46例患者采用开放式灌注尖端RF导管（第2组）。7例出现胃轻瘫（第1组6例，第2组1例）。第1组6例患者中有4例与胃轻瘫相关的症状在手术过程中开始出现。另外3例患者在术后72至96小时内以类似症状到我们的门诊就诊。对于第1组的胃轻瘫病例，下肺静脉的平均最低CB温度较低，左心房直径较小。治疗采用保守方法，患者在6个月随访时无残留症状。随访期间仍有残留症状的唯一患者在第2组。虽然CB消融术时临床明显的胃轻瘫相当常见，但该过程通常是可逆的。然而，RF消融造成的损害可能不那么容易逆转。总之，在冷冻消融过程中，下肺静脉温度较低和左心房较小可能与胃轻瘫风险增加有关，透视引导可能有助于避免这种并发症。
