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- W2164067110 abstract "We read the article by Knopp et al about endoscopic findings in patients after radiofrequency ablation (RFA) of atrial fibrillation (AF) with interest. Gastrointestinal abnormalities were detected by using esophagogastroduodenoscopy (EGD) in 77% (327 of 425) patients 1–3 days after RFA. Since EGD was carried out only after RFA, the following could not be assessed: how many of these abnormalities were indeed the direct consequence of RFA, and how many were already present before RFA and contributed to the pathogenesis of AF. How many of the 327 patients with lesions on EGD received proton-pump inhibitors or H2 blockers before RFA? An association of gastroesophageal reflux disease (GERD) with AF is suggested by clinical and epidemiological studies. One pathomechanism of AF in GERD may be local inflammation penetrating the esophageal wall and thus affecting the adjacent vagal nerves. The innervation of the esophageal mucosa is altered in response to inflammation. Inflammation of the esophageal mucosa may trigger afferent-efferent reflex mechanisms with involvement of the cerebral representation of cardiac modalities and thus lead to secondary affection of the vagal nerves. In addition, GERD may lead to a release of inflammatory mediators or to an autoimmune response, which may affect the atrial myocardium or the cardiac conduction system. Thus, it would be of interest if the included patients with gastroesophageal abnormalities had a higher recurrence rate of AF after RFA than did patients with normal EGD findings. How was gastroparesis defined, and how was regression of gastroparesis diagnosed during follow-up? Based on which observations do the authors conclude that gastroparesis can be attributed to RFA when they do not have evidence for gastroparesis before RFA? Gastroparesis may be multicausal including vagal denervation or direct affection of smooth muscle cells. Were there any patients who developed atrioesophageal fistula during the recruitment period? Did these patients show any abnormalities at EGD? Patients with AF frequently receive oral anticoagulant drugs, and some of them, such as dabigatran, are known to have gastrointestinal side effects. Was there any association between the type of anticoagulant drugs between patients with and without gastrointestinal abnormalities? Many patients with AF develop stroke/embolism. Was there a difference in the frequency of EGD abnormalities between those with and without a previous stroke/embolism? AF may be due to cardiac involvement in a neuromuscular disorder. How many of the patients undergoing RFA had a muscle disease? In conclusion, more data about the complex relationship between the esophagus, the left atrium, and its nerval connections are necessary." @default.
- W2164067110 created "2016-06-24" @default.
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- W2164067110 date "2014-09-01" @default.
- W2164067110 modified "2023-09-26" @default.
- W2164067110 title "To the Editor—Left atrium, vagal nerve, and esophagus: A neighborhood with close relations" @default.
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- W2164067110 doi "https://doi.org/10.1016/j.hrthm.2014.05.030" @default.
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