Key result
Cryoballoon PVI plus roof ablation causes symptomatic gastroparesis in ~2% of patients, linked to lower BMI.
Why the study?
What pre-procedural CT anatomical and clinical characteristics are associated with symptomatic gastroparesis in patients undergoing cryoballoon pulmonary vein isolation and left atrial roof ablation for persistent atrial fibrillation?
Cohort (n=265)
What pre-procedural CT anatomical and clinical characteristics are associated with symptomatic gastroparesis in patients undergoing cryoballoon pulmonary vein isolation and left atrial roof ablation for persistent atrial fibrillation?
Lower BMI, wider left atrial-esophageal contact on pre-procedural CT, and lower esophageal temperatures during left atrial roof ablation are associated with post-cryoballoon gastroparesis, suggesting CT imaging may help risk-stratify patients prior to ablation.
Pre-procedural CT does not yet guide gastroparesis risk before CBA; leaves open prospective validation of imaging protocols.
Periesophageal vagal nerve injury-induced gastroparesis is a rare but significant complication of cryoballoon ablation (CBA) for atrial fibrillation (AF). Data on the utility of pre-procedural computed tomography (CT) imaging for identifying patients at risk remain limited. We retrospectively analyzed 265 consecutive patients with persistent or long-standing persistent AF who underwent pulmonary vein isolation (PVI) and left atrial roof ablation (LARA) using a cryoballoon system. Symptomatic gastroparesis occurred in 5 patients (1.9%). Patients with gastroparesis had a significantly lower body mass index (BMI; 20.0 ± 3.3 vs. 23.8 ± 3.5 kg/m², P = 0.008). During LARA, the number of cryoballoon applications with esophageal temperature < 25 °C was higher (1.0 ± 0.6 vs. 0.3 ± 0.5, P = 0.004) and the nadir temperature was lower (21.3 ± 7.7 vs. 28.2 ± 6.3 °C, P = 0.01). CT analysis showed a longer left atrium (LA)–esophagus contact length and shorter distances between the esophagus and adjacent structures (spine and aorta) in patients with gastroparesis. All cases recovered with conservative treatment. Lower BMI, wider atrial–esophageal contact on CT, and lower esophageal temperature during LARA were associated with gastroparesis following CBA. Pre-procedural CT imaging may help identify patients at higher risk and inform procedural strategies to minimize periesophageal nerve injury.
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Shimosato et al. (2026) conducted a cohort in Persistent or long-standing persistent atrial fibrillation (n=265). Pulmonary vein isolation and left atrial roof ablation using a cryoballoon system (evaluated via pre-procedural CT and procedural characteristics) vs. Patients without symptomatic gastroparesis (n=260) was evaluated on Symptomatic gastroparesis following cryoballoon ablation. Cryoballoon PVI and left atrial roof ablation resulted in symptomatic gastroparesis in 1.9% of patients, associated with lower BMI (20.0 vs 23.8 kg/m², P=0.008) and lower nadir temperature (P=0.01).
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