Abstract 12104: Asymptomatic Acute Complications of Atrial Fibrillation Ablation Using Irrigated Radiofrequency Technology

Abstract

Introduction: Complications after atrial fibrillation (AF) ablation are rare and therefore consequent analysis of risk factors is often hard. Although, in asymptomatic patients silent cerebral events (SCE) in magnetic resonance imaging (MRI) and endoscopically detected esophageal thermal lesions (EDEL) have been documented in a much higher percentage of these patients. These asymptomatic complications may serve as surrogate indicators for the potential for severe complications. Hypothesis: We evaluated the incidence of SCE and EDEL in patients undergoing AF ablation using irrigated radiofrequency ablation technologies. Methods: Overall 375 pts undergoing either single-tip contact-force irrigated RF ablation (N=231) or multipolar irrigated RF (nMARQ, N= 170). EDEL using post-ablation endoscopy (days 1 - 4) and SCE using diffusion-weighted brain MRI (days 1 - 3) were documented and related to procedural and patient-specific parameters. No symptomatic complications occurred in this patient cohort. Results: 327 pts underwent post-ablation endoscopic evaluation for EDEL and 335 post-ablation MRI to detect SCE. Overall incidence of EDEL was 16% (53) including 4.5% (15) esophageal ulcers and 21% (72) had SCE. In the single-tip RF ablations 12% had EDEL and 20% SCE whereas in the nMARQ ablations 21% had EDEL and 23% SCE. The incidence of EDEL was higher in patients undergoing esophageal temperature monitoring using a thermal esophagus probe with non-insulated large metal electrodes (30% versus 6% in single tip and 31% versus 6% in nMARQ ablations). The use of this specific probe was the only independent predictor of EDEL. The incidence of SCE was relevantly lower in patients ablated under continuous oral anticoagulation (12% versus 37% for single tip and 15%versus 31% for nMARQ ablations). Conclusions: AF ablation using irrigated RF involves a risk of asymptomatic complications to the esophagus and brain relevantly higher than symptomatic complications. Reduction of asymptomatic complications may warrant beneficial effects on the most severe complications of AF ablation like periprocedural stroke and atrio-esophageal fistula.