Symptomatic esophagogastric hypomotility a year after cryoablation for atrial fibrillation: a case report

Abstract

Background

Cryoballoon (CB) ablation is a safe and effective treatment for atrial fibrillation (AF). However, complications, such as esophagogastric hypomotility (EGH) secondary to vagal nerve injury (VNI), have been reported.

Case summary

We present the case of a 71-year-old woman with paroxysmal AF who underwent CB ablation. The patient did not report any gastrointestinal symptoms during the procedure. Precisely 4 months later, an upper gastrointestinal endoscopy during a routine health check revealed food retention in the stomach. Eleven months after the CB ablation, the patient was admitted to the emergency room on account of chest tightness. Computed tomography showed a large amount of food residue in the esophagus. Esophagogastroscopy revealed retained food in the esophagus without any apparent obstruction.

Conclusion

EGH, particularly secondary to VNI post CB ablation, poses diagnostic and management challenges. Our case highlights the limitations of current strategies in preventing EGH, including freeze duration, frequency adjustments, and esophageal temperature monitoring. Additionally, late-onset symptomatic EGH underscores the need for long-term follow-up care post CB ablation.

Learning objective

We present a case of asymptomatic gastric hypomotility, post-ablation, which developed symptomatic esophagogastric hypomotility one year after the procedure. Late-onset symptomatic esophagogastric, especially esophageal hypomotility have not been previously reported. Freeze duration, times and esophageal temperature monitoring may not avoid esophagogastric hypomotility. Esophagogastric motility disorders may persist longer than previously reported.