Evaluation of periesophageal nerve injury after pulmonary vein isolation using the (13)C-acetate breath test

The Impact of Diet and Regular Mixers on Breath Alcohol Concentration: A Comparative Study

OBJECTIVE

The use of alcoholic beverages with 'diet' mixers is becoming more popular. The purpose of this study was to assess BrAC and the pace of stomach emptying in healthy volunteers after consuming either sucrose-containing or artificially sweetened alcoholic beverages.

METHOD

This was a two-way crossover trial with an open label. The subjects consumed alcohol on two consecutive occasions conducted in the morning (9:00am-12:00pm), once with diet coke and once with standard coke. In a randomised order, twelve healthy participants (n=12, 8 male and 4 female) aged 19-64 years were studied twice. They drank a standardised (0.5g/kg body weight) volume of vodka (37.5% ABV) over a time period of 1minute in each session, prepared with either 'regular' coke with 35g sugar in 330mL or 'diet' coke with artificial sweetener which is aspartame. Their BrAC was measured every 15minutes for 3hours. Their breath samples for stomach emptying measurement were taken separately in breath bags right after the breath alcohol measurement. The the gastric half-emptying time (t1/2) and lag phase time (tlag) characteristics of these breath samples were determined.

RESULTS

Diet coke increased both the peak BrAC (38.3±9.45 vs. 34.8±6.82 μg/100mL) and the area under the breath ethanol curve between 0 and 180minutes (45249.0±95.7 vs. 40439.25±72.5 μg·min/L). Using nonlinear regression analysis, the diet drink showed a shorter half-emptying time (t1/2) than the regular drink (100.09±35.42 vs. 110.74±66.71min), while the lag phase (tlag) was slightly longer (49.35±13.52 vs. 46.63±13.90min)."

CONCLUSIONS

This study emphasises the need of considering factors other than the alcohol level of a drink when determining safe quantities of intake and the potential of intoxication. The lack of sucrose in diet mixers may cause faster stomach emptying of alcohol, increasing its absorption rate into the blood, resulting in higher peak BrAC and increased exposure to other alcohol-related dangers.

A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation

Recently, myocardial extracellular volume (ECV) analysis has been measurable on computed tomography (CT) using new software. We evaluated the use of cardiac CT to estimate the myocardial ECV of left ventricular (LV) myocardium (LVM) to predict reverse remodeling (RR) in cases of atrial fibrillation (AF) after catheter ablation (CA). Four hundred and seven patients underwent CA for AF in our institution from April 2014 to Feb 2021. Of these, 33 patients (8%) with an LVEF ≤ 50% and who had undergone CT were included in our study. We estimated the LVM ECV using commercial software to analyze the CT data. RR was defined as an improvement in LVEF to > 50% after CA. LVEF increased to > 50% in 24 patients (73%) after CA. In all 24 patients, LVM ECV, LV end-diastolic and end-systolic volumes (LVEDV and LVESV), and the n-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) were significantly lower than in the other nine patients (P = 0.0037, 0.0273, 0.0443, and < 0.0001). On receiver operating characteristic curve analysis, the best cut-off of ECV, LVEDV, LVESV and NT-proBNP for the prediction of RR were 37.73%, 120 mL, 82 mL, and 1267 pg/mL, respectively. We newly defined the ENL (ECV, NT-proBNP, and LVEDV) score as the summed score for the presence or absence (1 or 0; maximum score = 3) of ECV, NT-proBNP, and LVEDV values less than or equal to each best cut-off value, and found that this score gave the highest area under the curve for the prediction of RR (0.9583, P < 0.0001). The ENL score may be useful for predicting RR in patients with AF undergoing CA.

Upper gastrointestinal complications following ablation therapy for atrial fibrillation

BACKGROUND

Following ablation therapy for cardiac arrhythmias, patients may develop upper gastrointestinal (UGI) symptoms. The vagus nerve is close to the atria and may be affected by ablating energy.

AIM

To identify structural or functional complications in UGI tract following ablation for atrial fibrillation (AF) and clinical outcomes and association with vagal dysfunction.

METHODS

Using natural language processing of electronic medical records and an AF ablation database of 5380 patients treated during 17 years, we identified 40 patients with UGI complications. We evaluated vagal dysfunction by electrocardiogram (ECG) showing lack of sinus arrhythmia (variation in R-R interval by ≥120 milliseconds, in presence of normal sinus P waves and constant P-R interval).

KEY RESULTS

Among 40 patients: (A) eight had structural GI complications confirmed by diagnostic tests: seven with esophageal ulcer/erosions and no signs of UGI bleeding and one developed esophagopericardial fistula (and survived with treatment); (B) 15 had functional UGI complications confirmed by objective motility tests. Nine had newly developed symptoms and six had aggravated symptoms; and (C) the remaining 17 had GI symptoms without relevant diagnostic results. Most UGI issues resolved spontaneously or with conservative treatment. However, 2 died several weeks after ablation procedure; cause of death was suspected atrioesophageal fistula or esophageal rupture. Vagal dysfunction persisted for 3 months in 13 and was transient in 8.

CONCLUSIONS/INFERENCES

Although most GI issues resolved spontaneously, there should be a high index of clinical suspicion in patients with persistent symptoms. Vagal dysfunction may serve as a marker of more extensive tissue damage.