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Gastroparesis: a Rare Complication After A-Fib Ablation

Gastroparesis is a condition in which your stomach empties into your small intestine more slowly than it should. It can be either temporary or chronic. Gastroparesis can occur after surgery or another medical procedure that interrupts your digestion.

Symptoms of Gastroparesis

When you have Gastroparesis, you feel bloated after eating, you may have stomach pain, or you may be vomiting. You may lose weight, your blood sugar levels may fluctuate, you may be dehydrated, your esophagus may be inflamed and you may experience malnutrition because your stomach isn’t absorbing nutrients.

Gastroparesis After Catheter Ablation

Gastroparesis is a rare complication of A-Fib ablation. It’s a condition that affects the stomach muscles and prevents proper stomach emptying. If after your catheter ablation, you experience any of the above symptoms, you may be experiencing Gastroparesis.

The cause can be damage to the vagal nerve which controls the stomach muscles. This can happen when ablation at the right inferior Pulmonary Vein (PV) affects the esophagus. The distance between the right inferior PV (RIPV) and the esophagus is an independent predictor of gastroparesis.

Pre-disposition to this complication may relate to a patient’s anatomical distribution of nerves in the esophagus (vagal). Some patients may have a neural network limited to the anterior esophageal wall rather than a circumferential distribution.

Atrio-esophageal fistula is an extremely rare but often fatal late complication of catheter ablation procedures resulting from massive thermal injury to the esophagus and surrounding structures.

As with an atrio-esophageal fistula (another rare post-ablation complication), too much thermal energy during an ablation may damage the anterior nerves affecting the stomach.

The good news is that modified ablation strategies have reduced the duration of RF energy to the heart’s posterior wall. This has reduced the incidence of both esophageal fistula and gastroparesis.

Gastroparesis is Reversible

In general, gastroparesis is reversible. A Gastric emptying scan can determine how quickly food leaves the stomach. Medications such as Metoclopramide can help. It speeds up stomach emptying and movement of the upper intestines. Dietary adjustments can work as well.

The article Gastroparesis Diet by Healthline.com has advice on gastroparesis with a list of foods to eat and to avoid. They advise to avoid fiber and fats which are harder to digest. Eat small, frequent meals that are low in fat and easy to digest. Include high-protein foods (such as eggs and nut butter) and easy to digest vegetables (such as cooked zucchini).

Don’t Ignore Gastroparesis Symptoms

It’s normal to feel strange after a catheter ablation, especially during the 3-month blanking/ healing period. But if you experience any Gastroparesis symptoms as described above, tell your EP or GP. You may have to be insistent to be checked for gastroparesis.

Gastroparesis is such a rare complication of A-Fib ablation that few EPs may have seen patients with  it. But once you are properly diagnosed, it’s usually reversible.

The bottom line is, as uncomfortable as Gastroparesis feels, it’s generally a temporary complication. (And it’s still a huge improvement over being in A-Fib.)

Thanks to Chris Bogus for calling our attention to this possible, though rare, complication of catheter ablation for A-Fib. He recommends the book, Living (Well!) with Gastroparesis: Answers, Advice, Tips & Recipes for a Healthier, Happier Lifeby Crystal Zaborowski Saltrelli CHC

Resources for this article
• Co, M. L. et al. Gastroparesis: A Rare but Reversible Complication of Atrial Fibrillation Ablation. Journal of the American College of Cardiology, Volume 73, Issue 9 Supplement 1, March 2019. http://www.onlinejacc.org/content/73/9_Supplement_1/2327. DOI: 10.1016/S0735-1097(19)32933-X

• Gastroparesis Diet. https://www.healthline.com/health/gastroparesis/gastroparesis-diet

•  Living (Well!) with Gastroparesis: Answers, Advice, Tips & Recipes for a Healthier, Happier Lifeby Crystal Zaborowski Saltrelli CHC

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