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\begin{document}

\title{Acute myocardial infarction followed by radiofrequency therapy for
gastroesophageal reflux disease in a man: a case report}



\author[1]{Zhihong Xu}%
\author[2]{suyu he}%
\author[1]{Xin Xiong}%
\author[1]{Xiumei Zhang}%
\author[1]{Caiju Feng}%
\author[1]{Shilin Tang}%
\author[2]{Yijun Liu}%
\author[1]{lili Wu}%
\affil[1]{Zunyi Medical University}%
\affil[2]{Suining Central Hospital}%


\vspace{-1em}



  
  \date{May 20, 2024}


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\begin{abstract}
Coronary artery disease (CAD) is a common comorbidity of
gastro-esophageal reflux disease (GERD). Since the distal esophagus and
heart share a common afferent vagal supply, the delivery of
radiofrequency in the distal esophagus can stimulate the coronary artery
and induce acute myocardial infarction (AMI) in a patient with CAD.%
\end{abstract}%



\sloppy


\textbf{Acute myocardial infarction followed by radiofrequency therapy
for gastroesophageal reflux disease in a man: a case report}

Zhihong Xu\textsuperscript{1}, Suyu He\textbf{*} \textsuperscript{1,2},
Xin Xiong\textsuperscript{1}, Xiumei Zhang\textsuperscript{1}, Caiju
Feng\textsuperscript{1}, Shilin Tang\textsuperscript{2}, Yijun
Liu\textsuperscript{3}, Lili Wu\textsuperscript{1}

\textsuperscript{1}Zunyi Medical University, Zunyi, China, 563000.

\textsuperscript{2}The Fourth Department of the Digestive Disease
Center, Suining Central Hospital, Suining, China, 629000.

\textsuperscript{3}The Department of Cardiovascular, Suining Central
Hospital, Suining, China.

\textbf{*Corresponding author: Suyu He}

Address: The Fourth Department of the Digestive Disease Center, Suining
Central Hospital, Suining, China, 629000.\emph{Tel:+8618008258565} Fax:
+868252292270

E-mail: hesuyu2009@163.com

\textbf{Abstract}

Coronary artery disease (CAD) is a common comorbidity of
gastro-esophageal reflux disease (GERD). Since the distal esophagus and
heart share a common afferent vagal supply, the delivery of
radiofrequency in the distal esophagus can stimulate the coronary artery
and induce acute myocardial infarction (AMI) in a patient with CAD.

\textbf{Key words:} coronary artery disease; acute myocardial
infarction; gastroesophageal reflux disease; radiofrequency therapy.

\textbf{Case presentation}

Since the first report in 2001, esophageal radiofrequency (RF) therapy
has proven to be safe and effective in treating refractory
gastroesophageal reflux disease (GERD) {[}1,2{]}. More than 25,000
refractory GERD patents have undergone RF therapy over the last 17 years
{[}2,3{]}. However, is it a safe choice for patients with refractory
GERD and other comorbidities? Here, we report a case of acute myocardial
infarction (AMI) followed by RF therapy. Although acute coronary disease
can exist simultaneously with GERD {[}3,4{]}, to the best of our
knowledge, no reports describe ACI followed by RF therapy in GERD
patients.

A 62-year-old man presented with a 4-year history of heartburn. The
symptoms were aggravated by lying down and relieved by proton pump
inhibitors (PPIs). He has a history of high blood pressure. Calcium
channel blockers were taken routinely, and blood pressure was controlled
well. Laboratory investigation was normal except for high cholesterol
(5.6 mmol/L). Esophagogastroduodenoscopy (EGD) was normal. Esophageal
motility was normal, but lower esophageal sphincter (LES) pressure was
5.8 mmHg. The 24-hour pH showed an acid exposure time (AET) of 9.1\%, a
DeMeester score of 31.29, and 109 reflux episodes.

Esophageal RF therapy was implemented to reduce or even stop PPIs usage.
Under general anesthesia with endotracheal intubation, RF therapy was
performed successfully in 40 minutes. Immediately after the delivery of
RF energy, heat-induced small cautery burns were seen around the cardia
(arrow) (Figure A, B). Eight hours after the procedure, the patient
suddenly complained of more severe heartburn accompanied by chest pain
and pressing feelings. The emergency white blood cell (WBC) count was
13.5x10\textsuperscript{9}/L, cardiac troponin was positive, and
electrocardiogram (ECG) showed obviously elevated V1-V3. AMI was
confirmed with subsequent coronary angiography which showed 80\% stent
of the left anterior descending coronary artery (arrow) (Figure C). And
his symptom was disappeared followed by the stent implantation into the
stenosis vessel (arrow) (Figure D).

This case underscores the importance of excluding coronary artery
disease (CAD) in patients with GERD, especially those with risk factors
for CAD, before RF therapy. Since the distal esophagus and heart are
adjacent and share a common afferent vagal supply, the delivery of RF in
the distal esophagus and/or cardia may stimulate the coronary artery and
induce AMI in a patient with CAD {[}5{]}. CAD should likely be a
relative contraindication for RF therapy in the treatment of refractory
GERD.

\textbf{Ethics statement}

Ethics approval was obtained from the Ethics Committee at Suining
Central Hospital, Sichuan, China. The patient involved in this report
provided written informed consent for the data regarding his case. The
patient agreed to undergo all the treatments.

\textbf{Consent for publication}

Written informed consent was obtained from the patient for publication
of this case report and any accompanying images.

\textbf{Declaration of conflicting interest}

The authors declare that there are no conflicts of interest.

\textbf{Funding}

This research received no specific grant from any funding agency in the
public, commercial, or not-for-profit sectors.

\textbf{Authors' contributions}

XZ drafted the manuscript; XX, ZX, FC, TS, LY and WL collected the
patient information. HS served as the final diagnosis as well as senior
author managing the construction and edits of the manuscript and guiding
the primary author through the submission process.

ORCID iD

Suyu He: https://orcid.org/0000-0002-4541-6865

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Richards WO, Scholz S, Khaitan L, Sharp KW, Holzman MD. 2001. Initial
  experience with the stretta procedure for the treatment of
  gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A
  11:267-73.
\item
  Vaezi MF, Shaheen NJ, Muthusamy VR. 2020. State of Evidence in
  Minimally Invasive Management of Gastroesophageal Reflux: Findings of
  a Scoping Review. Gastroenterology 159:1504-1525.
\item
  Sandhu DS, Fass R. 2018. Current trends in the Management of
  Gastroesophageal Reflux Disease. Gut Liver 12:7-16.
\item
  Teragawa H, Oshita C, Ueda T. 2019. History of gastroesophageal reflux
  disease in patients with suspected coronary artery disease. Heart
  Vessels 34:1631-1638.
\item
  Eisa M, Sandhu A, Prakash R, Ganocy SJ, Fass R. 2020. The Risk of
  Acute Myocardial Infarction in Patients With Gastroesophageal Reflux
  Disease. J Neurogastroenterol Motil 26:471-476.
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