Key result
PFA for AF triggers acute gastric dilatation and portal venous gas, resolving with conservative management.
Why the study?
Although pulsed field ablation is considered to reduce collateral extracardiac injury compared with conventional thermal ablation, its transient effects on autonomic nerves and adjacent smooth-muscle structures remain incompletely characterized.
Case Report (n=1)
No
This case report highlights the potential for transient gastrointestinal dysmotility, presenting as acute gastric dilatation and secondary portal venous gas, following extensive pulsed field ablation near the left inferior pulmonary vein.
Background Pulsed field ablation (PFA) is considered to reduce collateral extracardiac injury compared with conventional thermal ablation. However, transient effects on autonomic nerves and adjacent smooth-muscle structures remain incompletely characterized. Case summary An 80-year-old lean man underwent PFA for paroxysmal atrial fibrillation using a variable-loop circular catheter. Because stable tissue proximity was difficult to achieve around the left inferior pulmonary vein (LIPV), additional ablation sets were delivered in this region. Approximately 24 hours after the procedure, the patient developed acute abdominal pain. Computed tomography demonstrated marked gastric dilatation and portal venous gas with elevated lactate levels, without superior mesenteric artery occlusion or findings of irreversible bowel necrosis. Nasogastric decompression, fasting, intravenous fluids, and antibiotics resulted in rapid clinical and biochemical improvement. Portal venous gas resolved on follow-up imaging, oral intake was resumed, and the patient was discharged without surgical intervention. Discussion The temporal relationship raises the possibility of a PFA-associated transient gastrointestinal dysmotility, although causality cannot be established from a single case. Potential mechanisms include transient effects on the periesophageal vagal plexus and/or adjacent smooth muscle. Portal venous gas was likely secondary to marked gastric dilatation rather than a direct effect of PFA.
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Sakaki et al. (2026) conducted a case report in Paroxysmal atrial fibrillation (n=1). Pulsed field ablation using a variable-loop circular catheter was evaluated on Acute gastric dilatation and portal venous gas. Pulsed field ablation for paroxysmal atrial fibrillation in an 80-year-old man was followed ~24 hours later by acute gastric dilatation and portal venous gas, resolving conservatively.
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