Evaluation of periesophageal nerve injury after pulmonary vein isolation using the13 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. The13 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 of13 CO2 ( Tmax ). 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 Tmax (≥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 Tmax 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 Δ Tmax 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.