Acute Gastric Hypomotility Following Treatment for Atrial Fibrillation

Background Catheter ablation has become a standard therapeutic strategy for atrial fibrillation (AF), with pulmonary vein isolation (PVI) commonly achieved using cryoballoon ablation (CBA) or radiofrequency ablation (RFA). Although CBA is associated with fewer severe complications and shorter procedural times, collateral injury to adjacent structures, such as the esophagus and periesophageal vagal plexus, can occasionally occur. Gastric hypomotility (GH) secondary to vagal nerve injury is a rare but clinically important complication that may present with nonspecific gastrointestinal symptoms. Case Presentation A 46‐year‐old woman with no history of smoking or alcohol use was diagnosed with tachycardia‐induced cardiomyopathy and heart failure due to AF. After stabilization, she underwent PVI using second‐generation CBA at another institution. Two days postprocedure, she developed abdominal pain, nausea, and upper abdominal distension. Physical examination revealed mild epigastric distension without tenderness. Laboratory findings were unremarkable except for mild elevation in blood urea nitrogen and C‐reactive protein. Abdominal radiography and CT demonstrated marked gastric dilatation without mechanical obstruction. Upper gastrointestinal endoscopy showed retained food residue in the stomach but no structural lesions. Based on these findings, postablation GH due to periesophageal vagal nerve injury was diagnosed. Treatment and Outcome Conservative outpatient management was initiated, including mosapride citrate (15 mg/day in divided doses) and a low‐fat, low‐fiber diet. The patient’s symptoms gradually improved within one month, and follow‐up imaging at three months confirmed complete resolution of gastric dilatation. No recurrence was observed during six months of follow‐up. Conclusion GH following CBA for AF is a rare but notable complication caused by vagal nerve injury. Early recognition through clinical and radiologic assessment allows effective conservative management, avoiding unnecessary invasive procedures. This case highlights the importance of multidisciplinary awareness and prompt intervention in achieving favorable outcomes.