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Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report

Patient: Male, 74-year-old Final Diagnosis: Atrial flutter • Barrett’s esophagus Symptoms: Palpitations • dyspnea • chest pain Clinical Procedure: Atrial flutter ablation • laparoscopic Nissen fundoplication • radiofrequency ablation (RFA) procedure with the Barrx™ catheter system Specialty: Cardiol...

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Autores principales: Fassari, Alessia, De Blasi, Vito, Basile, Marco, Perretta, Silvana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565709/
https://www.ncbi.nlm.nih.gov/pubmed/37794654
http://dx.doi.org/10.12659/AJCR.941264
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author Fassari, Alessia
De Blasi, Vito
Basile, Marco
Perretta, Silvana
author_facet Fassari, Alessia
De Blasi, Vito
Basile, Marco
Perretta, Silvana
author_sort Fassari, Alessia
collection PubMed
description Patient: Male, 74-year-old Final Diagnosis: Atrial flutter • Barrett’s esophagus Symptoms: Palpitations • dyspnea • chest pain Clinical Procedure: Atrial flutter ablation • laparoscopic Nissen fundoplication • radiofrequency ablation (RFA) procedure with the Barrx™ catheter system Specialty: Cardiology • Gastroenterology and Hepatology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Barrett’s esophagus (BE) is a metaplastic change in the normal esophageal squamous epithelium and is a well-recognized precursor of esophageal adenocarcinoma (EAC). Nowadays, focal radiofrequency ablation is a valid technique for BE treatment by inducing a superficial and focal thermic destruction of metaplastic tissues. According to the literature, the most frequent patient-related adverse events of this procedure are esophageal iatrogenic stenosis, mucosal laceration or perforation of the esophagus, chest pain, and odynophagia/dysphagia. Postoperative heart rhythm abnormalities have been reported very rarely. CASE REPORT: A 74-year-old patient with HE was treated by radiofrequency ablation (RFA) with the Barrx™ catheter system. He had 2 symptomatic episodes of atrial flutter in the immediate postoperative period requiring an external electrical cardioversion to induce a return to sinus cardiac rhythm. After atrial flutter ablation, 2 more radio-frequency procedures were performed, without adverse events. A laparoscopic Nissen fundoplication was carried out with complete endoscopic and histologic eradication of BE after 12-month follow-up. To the best of our knowledge, this is the first reported case of atrial flutter after esophageal RFA. Different mechanisms acting on an anatomic predisposing substrate can potentially play a role in starting atrial flutter, and include inflammation, autonomic activation, and myocardial injury. CONCLUSIONS: The occurrence of this new type of adverse effect could potentially modify indications and postoperative monitoring of RFA treatment for BE. Endoscopists should know the possibility of this procedural complication in high-risk patients and they should propose alternative techniques or implement close cardiac monitoring in the postoperative period.
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spelling pubmed-105657092023-10-12 Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report Fassari, Alessia De Blasi, Vito Basile, Marco Perretta, Silvana Am J Case Rep Articles Patient: Male, 74-year-old Final Diagnosis: Atrial flutter • Barrett’s esophagus Symptoms: Palpitations • dyspnea • chest pain Clinical Procedure: Atrial flutter ablation • laparoscopic Nissen fundoplication • radiofrequency ablation (RFA) procedure with the Barrx™ catheter system Specialty: Cardiology • Gastroenterology and Hepatology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Barrett’s esophagus (BE) is a metaplastic change in the normal esophageal squamous epithelium and is a well-recognized precursor of esophageal adenocarcinoma (EAC). Nowadays, focal radiofrequency ablation is a valid technique for BE treatment by inducing a superficial and focal thermic destruction of metaplastic tissues. According to the literature, the most frequent patient-related adverse events of this procedure are esophageal iatrogenic stenosis, mucosal laceration or perforation of the esophagus, chest pain, and odynophagia/dysphagia. Postoperative heart rhythm abnormalities have been reported very rarely. CASE REPORT: A 74-year-old patient with HE was treated by radiofrequency ablation (RFA) with the Barrx™ catheter system. He had 2 symptomatic episodes of atrial flutter in the immediate postoperative period requiring an external electrical cardioversion to induce a return to sinus cardiac rhythm. After atrial flutter ablation, 2 more radio-frequency procedures were performed, without adverse events. A laparoscopic Nissen fundoplication was carried out with complete endoscopic and histologic eradication of BE after 12-month follow-up. To the best of our knowledge, this is the first reported case of atrial flutter after esophageal RFA. Different mechanisms acting on an anatomic predisposing substrate can potentially play a role in starting atrial flutter, and include inflammation, autonomic activation, and myocardial injury. CONCLUSIONS: The occurrence of this new type of adverse effect could potentially modify indications and postoperative monitoring of RFA treatment for BE. Endoscopists should know the possibility of this procedural complication in high-risk patients and they should propose alternative techniques or implement close cardiac monitoring in the postoperative period. International Scientific Literature, Inc. 2023-10-05 /pmc/articles/PMC10565709/ /pubmed/37794654 http://dx.doi.org/10.12659/AJCR.941264 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Fassari, Alessia
De Blasi, Vito
Basile, Marco
Perretta, Silvana
Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title_full Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title_fullStr Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title_full_unstemmed Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title_short Atrial Flutter After Radiofrequency Ablation for Barrett’s Esophagus: A Case Report
title_sort atrial flutter after radiofrequency ablation for barrett’s esophagus: a case report
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565709/
https://www.ncbi.nlm.nih.gov/pubmed/37794654
http://dx.doi.org/10.12659/AJCR.941264
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