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Reply to the Editor—Left Atrium, Vagal Nerve, and Esophagus: A Complex System in Atrial Fibrillation
Author's Accepted Manuscript
Left Atrium, Vagal Nerve and Esophagus: a Complex system in Atrial Fibrillation Daniela Husser, Helge Knopp, Andreas Bollmann, Gehard Hindricks, Ulrich Paul Halm
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1547-5271(14)00615-8 http://dx.doi.org/10.1016/j.hrthm.2014.05.029 HRTHM5792
To appear in:
Heart Rhythm
Cite this article as: Daniela Husser, Helge Knopp, Andreas Bollmann, Gehard Hindricks, Ulrich Paul Halm, Left Atrium, Vagal Nerve and Esophagus: a Complex system in Atrial Fibrillation, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2014.05.029 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Response to Commentary
Left atrium, vagal nerve and esophagus: a complex system in atrial fibrillation
Daniela Husser1, Helge Knopp1, Andreas Bollmann1, Gehard Hindricks1, Ulrich Paul Halm2
1
2
Department of Electrophysiology, Heart Center, Leipzig, Germany
Department of Internal Medicine II, Park Hospital, Leipzig, Germany
Word count: 305
Address for correspondence: Daniela Husser, MD Department of Electrophysiology Heart Center Leipzig Leipzig University Strümpellstrasse 39 04289 Leipzig phone: ++49 341 865 1410 fax: ++49 341 865 1460 [email protected]
We thank Stöllberger and Finsterer for their interest (1) in our work on endoscopic findings in 425 patients after radiofrequency catheter ablation of atrial fibrillation (AF) (2). The authors, who are known for their critical appraisal of original research and anecdotal reports, raise many important questions that highlight the complexity of the vagal nerve, the upper gastrointestinal (GI) tract and atrial anatomy and AF pathophysiology. While some of the points have already been addressed in our manuscript (definition and follow-up of gastroparesis, cause – effect relationship between GI pathologies and AF/AF ablation) others are beyond the scope of our paper and this letter (impact of dabigatran, GI pathologies in association with stroke), or have already been discussed by the authors themselves (local inflammation as contributor to AF). However, in response to the remaining questions we would like to extend our study by the following additional statements: Patients were included only if they had no known GI abnormalities. There were no gastroesophageal fistulas during follow-up. There was no association between gastroesophageal reflux disease and AF recurrences. The majority of our patients had vitamin-K antagonists as anticoagulation treatment since recruitment was done before the release of novel anticoagulants. There were no patients with known neuromuscular disease. In summary, we concur with the authors that “more data about the complex relation between esophagus, left atrium and its nerval connections are necessary” and invite them to be part of this interesting quest for answers.
References 1.
Stöllberger C, Finsterer J. Left atrium, vagal nerve and esophagus: a neighborhood with close relations. Heart Rhythm. 2014; XXX.
2.
Knopp H, Halm U, Lamberts R, Knigge I, Zachäus M, Sommer P, Richter S, Bollmann A, Hindricks G, Husser D. Incidental and ablation-induced findings during upper gastrointestinal endoscopy in patients after ablation of atrial fibrillation: a retrospective study of 425 patients. Heart Rhythm. 2014;11(4):574-8.
Left Atrium, Vagal Nerve and Esophagus: a Complex system in Atrial Fibrillation Daniela Husser, Helge Knopp, Andreas Bollmann, Gehard Hindricks, Ulrich Paul Halm
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1547-5271(14)00615-8 http://dx.doi.org/10.1016/j.hrthm.2014.05.029 HRTHM5792
To appear in:
Heart Rhythm
Cite this article as: Daniela Husser, Helge Knopp, Andreas Bollmann, Gehard Hindricks, Ulrich Paul Halm, Left Atrium, Vagal Nerve and Esophagus: a Complex system in Atrial Fibrillation, Heart Rhythm, http://dx.doi.org/10.1016/j.hrthm.2014.05.029 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Response to Commentary
Left atrium, vagal nerve and esophagus: a complex system in atrial fibrillation
Daniela Husser1, Helge Knopp1, Andreas Bollmann1, Gehard Hindricks1, Ulrich Paul Halm2
1
2
Department of Electrophysiology, Heart Center, Leipzig, Germany
Department of Internal Medicine II, Park Hospital, Leipzig, Germany
Word count: 305
Address for correspondence: Daniela Husser, MD Department of Electrophysiology Heart Center Leipzig Leipzig University Strümpellstrasse 39 04289 Leipzig phone: ++49 341 865 1410 fax: ++49 341 865 1460 [email protected]
We thank Stöllberger and Finsterer for their interest (1) in our work on endoscopic findings in 425 patients after radiofrequency catheter ablation of atrial fibrillation (AF) (2). The authors, who are known for their critical appraisal of original research and anecdotal reports, raise many important questions that highlight the complexity of the vagal nerve, the upper gastrointestinal (GI) tract and atrial anatomy and AF pathophysiology. While some of the points have already been addressed in our manuscript (definition and follow-up of gastroparesis, cause – effect relationship between GI pathologies and AF/AF ablation) others are beyond the scope of our paper and this letter (impact of dabigatran, GI pathologies in association with stroke), or have already been discussed by the authors themselves (local inflammation as contributor to AF). However, in response to the remaining questions we would like to extend our study by the following additional statements: Patients were included only if they had no known GI abnormalities. There were no gastroesophageal fistulas during follow-up. There was no association between gastroesophageal reflux disease and AF recurrences. The majority of our patients had vitamin-K antagonists as anticoagulation treatment since recruitment was done before the release of novel anticoagulants. There were no patients with known neuromuscular disease. In summary, we concur with the authors that “more data about the complex relation between esophagus, left atrium and its nerval connections are necessary” and invite them to be part of this interesting quest for answers.
References 1.
Stöllberger C, Finsterer J. Left atrium, vagal nerve and esophagus: a neighborhood with close relations. Heart Rhythm. 2014; XXX.
2.
Knopp H, Halm U, Lamberts R, Knigge I, Zachäus M, Sommer P, Richter S, Bollmann A, Hindricks G, Husser D. Incidental and ablation-induced findings during upper gastrointestinal endoscopy in patients after ablation of atrial fibrillation: a retrospective study of 425 patients. Heart Rhythm. 2014;11(4):574-8.