Radiofrequency Ablation for Atrial Arrhythmia After Esophagectomy.

BACKGROUND

New-onset atrial fibrillation is common after esophagectomy, whereas atrial premature contractions and atrial tachycardia are relatively uncommon.

CASE SUMMARY: A 73-year-old man developed paroxysmal palpitations after esophagectomy with gastric pull-up reconstruction for esophageal cancer. Symptoms persisted despite oral medication and worsened over the past year. The postadmission electrocardiogram revealed frequent atrial premature contractions and atrial tachycardia. Cardiac electrophysiology study and radiofrequency ablation were performed. Mapping indicated a close anatomical relationship between the gastric conduit and the atrial premature contraction focus. No arrhythmia recurrence was observed during follow-up.

DISCUSSION: This case highlights premature atrial complexes and atrial tachycardia after esophagectomy, refractory to drugs but successfully treated with ablation. The anatomical proximity of the gastric conduit to the ectopic focus suggests local mechanical irritation as a potential mechanism.

TAKE-HOME MESSAGES: New-onset atrial arrhythmias after esophagectomy may involve mechanical irritation from adjacent structures. When there is an inadequate response to pharmacotherapy, radiofrequency ablation represents an effective alternative.