PPI prophylaxis may protect against post-PVI mediastinal complications

Prophylaxis with proton pump inhibitors (PPI) can potentially avert mediastinal lesions associated with pulmonary vein isolation (PVI) among atrial fibrillation (AF) patients with pre-existing reflux oesophagitis, a recent study has shown.

The study included 71 AF patients (median age, 60 years; 75 percent male) who participated in the MADE-PVI* trial. Participants were assessed right before and the day after PVI to monitor for pre-existing gastrointestinal (GI) pathologies and the occurrence of related lesions.

Majority of patients (74.6 percent; n=53) had incidental clinically relevant endoscopic findings, defined as findings that had diagnostic or therapeutic relevance. Reflux oesophagitis (31.0 percent) and Barrett’s oesophagus (19.7 percent) were the most commonly reported cases.

Looking at the impact of these pre-existing GI pathologies, the researchers saw that reflux oesophagitis significantly correlated with the likelihood of developing post-PVI mediastinal oedema, increasing its odds by over threefold (odds ratio [OR], 3.3, 95 percent confidence interval [CI], 1.1–10.4; p=0.037).

In terms of frequency, mediastinal oedemas associated with PVI occurred in 64 percent of patients with pre-existing reflux oesophagitis, as opposed to only 38 percent in those without (p=0.041). Other pathologies, such as Barrett’s oesophagus or gastric/duodenal ulcers, had no such impact on PVI outcomes.

Notably, the researchers saw that patients who had consistently been taking PPIs before PVI also suffered significantly less frequently from pre-existing reflux oesophagitis (7 percent vs 37 percent; p=0.049). In turn, mediastinal oedema also occurred at a significantly lower rate among those with pre-PVI PPI use (21 percent vs 53 percent; p=0.036). PPI had no such effect on other incidental endoscopic findings.

*Mediastino-oesophageal Alterations Detected by Endosonography after PVI