Pins, Needles, and a Pounding Heart: A Post-Lap-Band Surprise

Neurologic and cardiovascular symptoms are uncommon complications of laparoscopic adjustable gastric banding (LAGB). Alterations in vagal tone have been reported, most commonly as vasovagal syncope or bradycardia. We describe a unique presentation of sinus tachycardia and paresthesias resulting from vagal nerve irritation due to gastric band adjustments. A 51-year-old woman with a past medical history of rheumatoid arthritis and laparoscopic adjustable gastric band surgery presented with episodic right-sided paresthesias, palpitations, and sinus tachycardia occurring predominantly during and after meals. Vital signs were normal, and initial blood tests were unremarkable. Telemetry revealed periods of sinus tachycardia up to 160 beats per minute. Extensive neurologic, infectious, and cardiopulmonary evaluation was unrevealing. Further history revealed similar symptoms following prior gastric band adjustment. After removing 4.2 mL of fluid from the gastric band, the patient had complete resolution of symptoms. Surgical placement of an adjustable gastric band is close to the anterior vagal trunk, which courses near the gastroesophageal junction. Placement or adjustments of the gastric band can irritate or compress the vagal nerve, leading to unintended autonomic responses. Even without symptoms at rest, expansion of the stomach from food can lead to a similar response. While vagal nerve stimulation normally produces bradycardia, this case demonstrates that vagal dysfunction can present with paradoxical sinus tachycardia and sensory symptoms, all of which resolved with decreased gastric band pressure. In patients with prior adjustable gastric banding, vagal nerve stimulation should be considered for unexplained autonomic or neurologic symptoms. Early recognition can prevent unnecessary testing and facilitate prompt management. This case highlights the importance of recognizing neurologic and cardiovascular complications of gastric banding to provide appropriate management.