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Right arrow Electrophysiology - arrhythmias

Ann Thorac Surg 2004;78:1836-1838
© 2004 The Society of Thoracic Surgeons

Case report

Prandial Atrial Fibrillation: Off-Pump Pulmonary Vein Isolation With Hiatal Hernia Repair

A. Marc Gillinov, MDa,*, Thomas W. Rice, MDa

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication July 10, 2003.

* Address reprint requests to Dr Gillinov, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F24, 9500 Euclid Ave, Cleveland, OH 44195, USA
gillinom{at}ccf.org

Frequent palpitations with eating developed in a 62-year-old man with a history of typical gastroesophageal reflux successfully treated by Nissen fundoplication 5 years previously. A Holter monitor demonstrated paroxysmal atrial fibrillation associated with eating. Barium swallow showed a slipped Nissen fundoplication with herniation into the chest. Under a single anesthetic, the patient had median sternotomy and off-pump pulmonary vein isolation with a bipolar radiofrequency clamp and transabdominal redo-Nissen fundoplication. A 24-hour Holter monitor performed 6 weeks after operation demonstrated a normal sinus rhythm with no atrial fibrillation. Barium swallow demonstrated an intact infradiaphragmatic repair.




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