AB-452654-1 ESOPHAGEAL PROTECTION STRATEGIES FOR ABLATION OF ATRIAL FIBRILLATION: COMPARATIVE RESULTS BASED ON CONSECUTIVE ENDOSCOPIC EVALUATION

Abstract

Catheter ablation is an effective treatment for restoring sinus rhythm in AF and has become a worldwide procedure. Although rare, atrioesophageal fistula (AEF) is among the most common lethal complications of this procedure. Several strategies have been employed to prevent esophageal lesions, including single and multi-sensor esophageal probes, different energy strategies, esophageal displacement and regular esophageal monitoring using esophagogastroduodenoscopy (EGD) to identify asymptomatic esophageal lesions that could evolve to AEF. As the occurrence of AEF is rare, one of the approaches to evaluate which strategy is more effective in preventing esophageal lesions is studying the incidence of asymptomatic on routine endoscopy. The objective of this study is to present the five-year experience of a systematic endoscopic surveillance of esophageal injury after AF catheter ablation and analyse if there is an appropriate strategy related to a lower incidence of lesions. This is a retrospective single center registry of all AF ablation procedures performed from 2016 to 2021, in which an endoscopy was performed after ablation in all cases. A total of 660 AF ablation procedures in 626 different patients were performed in that period. A control EGD data could be recorded in 609 ablation procedures (92,3%). Most of the patients were male with paroxysmal AF. Esophageal temperature monitoring with single Sensor Probe was performed in 48.4% and with multi–sensor probe in 24.4% of the cases. Most of the patients presented no esophageal lesions (71.8%). Mild lesion was found on 90 patients (14.8%) and severe lesion was found on 56 (9.2%) of them. The use of multisensor esophageal probe (P<0.001), male gender (P=0.007) and the use of PVAC (P=0.018) were correlated with less frequent thermal lesions on multivariate analysis. Most of the lesions were healed on control endoscopy. The incidence of esophageal lesions on routine EGD after AF catheter ablation is high, but most of the cases the lesion is spontaneously healed. The use of multisensor probe, PVAC and male gender were correlated to fewer thermal lesions.