Radiofrequency catheter ablation (RFCA) is a potentially curative method for treatment of highly symptomatic and drug-refractory atrial fibrillation (AF). gastroesophageal reflux was documented at impedance pH monitoring. Patient underwent RFCA with electrical disconnection of pulmonary vein. After two weeks patient started to complain of dysphagia for solids with acute chest-pain. The patient repeated HRM and impedance-pH monitoring 8 weeks after RFCA. HRM showed in all liquid swallows the typical spastic hypercontractile contractions consistent with the diagnosis of JE whereas impedance-pH monitoring resulted again negative for GERD. Esophageal dysmotility can represent a possible complication of RFCA for AF probably due to a vagal nerve injury and dysphagia appearance after this procedure must be timely investigated by HRM. before meals) with a moderate dysphagia and chest-pain relieve. A mild weight gain was observed after 2 months (3 kg). Given the persistency of symptoms and the weight loss patient is now under evaluation for endoscopic (botulin toxin injection and peroral endoscopic myotomy) or surgical approach (myotomy) for the treatment of dysmotility. Figure 2. High-resolution manometry trace 8 weeks after radiofrequency catheter ablation for atrial fibrillation. In all liquid swallows the typical hypercontractile contractions were present (with a greatest distal contractile integral = 15 637 mmHg · … Canagliflozin Discussion To date there is no available data regarding the impact of RFCA of left atrium on esophageal motility whereas esophageal lesion and in particular ulceration due to thermal injury is a Canagliflozin well-known complication of this procedure.6 In fact development of esophageal ulcerations has been found to be dependent on the Canagliflozin RFCA lesion set as well as the maximum energy delivered at the posterior left atrial wall.7 Also some authors believe that esophageal ulceration can be a potential Rabbit Polyclonal to CA14. precursor of a dramatic life-threatening condition the atrio-esophageal fistula. In order to reduce this complication many attempts were made to protect the esophagus during RFCA by Canagliflozin temperature monitoring active cooling or visualization of the esophageal program but all never have became effective.8 The damaging part of RFCA for the esophageal wall structure aswell as on surrounding nerves (vagus and phrenic ones) was investigated in a number of papers. In a recently available retrospective research Knopp et al9 evaluated endoscopic results of 425 individuals who underwent RFCA for AF. Most of them underwent top endoscopy 1-3 times after radiofrequency treatment and most of them had been GERD-like or dysphagia-like symptom-free. Pathological results had been demonstrated in 77% from the individuals including esophagitis and chronic gastritis. Nevertheless thermal lesions had been within 11% of instances and gastroparesis in 17% assisting the potential part of RFCA in harming esophagus as well as the near vagus nerve. Furthermore a earlier study offers reported that within 48 hours after AF ablation stomach discomfort and distension created even if in mere 1% of individuals 10 and an instance report of serious gastroparesis was released lately.11 The pathophysiology of JE remains unclear but different hypotheses have already been suggested. Hypertensive contractions could be linked to muscular hypertrophy supplementary to mechanised outflow blockage as JE have already been descripted in individuals with dysphagia after fundoplication or gastric music group.12 Yet in our case individual showed a standard esophageal anatomy without stricture or challenging in transit through esophagogastric junction. Another feasible hypothesis consumes account GERD that may be associated with upper body discomfort and hypertensive esophageal contractions. The prevalence of GERD can be observed to become higher after RFCA. Martinek et al2 examined patients before and after RFCA with upper endoscopy and pH monitoring. They reported the incidence of “de novo” GERD in 19% of patients after procedure Canagliflozin arguing that reflux rising could be attributable to a direct vagal stimulation that can lead to a decrease in lower esophageal sphincter tone. Interestingly Khan et al13 reported a case of JE brought on after lung transplantation. The young.