J Neurogastroenterol Motil.  2015 Oct;21(4):612-615. 10.5056/jnm15034.

Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited "Jackhammer Esophagus": A New Complication Due to Vagal Nerve Stimulation?

• Tolone S
• Savarino E
• Docimo L

• KMID: 2381310
• DOI: http://doi.org/10.5056/jnm15034

Abstract

Radiofrequency catheter ablation (RFCA) is a potentially curative method for treatment of highly symptomatic and drug-refractory atrial fibrillation (AF). However, this technique can provoke esophageal and nerve lesion, due to thermal injury. To our knowledge, there have been no reported cases of a newly described motor disorder, the Jackhammer esophagus (JE) after RFCA, independently of GERD. We report a case of JE diagnosed by high-resolution manometry (HRM), in whom esophageal symptoms developed 2 weeks after RFCA, in absence of objective evidence of GERD. A 65-year-old male with highly symptomatic, drug-refractory paroxysmal AF was candidate to complete electrical pulmonary vein isolation with RFCA. Prior the procedure, the patient underwent HRM and impedance-pH to rule out GERD or hiatal hernia presence. All HRM parameters, according to Chicago classification, were within normal limits. No significant 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.

Keyword

Atrial fibrillation; Catheter ablation; Esophageal dysmotility; Manometry; Jackhammer esophagus

MeSH Terms

Aged
Atrial Fibrillation*
Catheter Ablation*
Classification
Deglutition Disorders
Diagnosis
Electric Impedance
Esophageal Motility Disorders
Esophagus
Gastroesophageal Reflux
Hernia, Hiatal
Humans
Hydrogen-Ion Concentration
Male
Manometry
Muscle Spasticity
Pulmonary Veins
Swallows
Vagus Nerve Stimulation*