Abstract 12177: Analysis of the Primery Factor Which Predicts the Incidence of Esophageal Injury After Catheter Ablation of Atrial Fibrillation

Abstract

Background: Esophageal injury (EI) is a serious complication after radiofrequency catheter ablation (CA) of atrial fibrillation (AF).Although life-threatening complications are rare, CA of posterior wall of left atrium (LA) may result in EI ranging from mild erythema to ulceration. However, predictable factor of EI is unclear. A recent study appreciably suggested that postprocedural upper gastrointestinal tract endoscopy could identify EI, and higher intraesophageal temperature measured by a luminal esophageal temperature monitoring (ETM) was associated with the occurrence of EI. Until now, there is no widely accepted approach to minimize EI caused by CA for AF. Objective: We sought to identify risk factors of EI caused by CA for AF, and explore the potential management of EI in this study. Methods: Among 568 patients who underwent CA of AF, endoscopy was performed the next day after CA to examine for EI. The incidence of EI was compared between 260 patients who done ETM (ETM group) and 308 patients who didn’t done ETM (Non-ETM group) during CA. The Shortest Distance between esophagus and posterior left atrium measured on contrast Computed Tomography (SD-CT) was also compared between both groups. Results: No differences were observed between both groups in total number and amount of applications. However, EI occurred more frequently in Non-ETM group (9/260 patients; 3.4 % vs 27/308 patients; 8.8 %, p=0.042). There was no significant difference in SD-CT between ETM and Non-ETM group. However, SD-CT in patients with EI was significantly shorter than SD-CT in patients without EI, both in ETM (2.3±0.6 vs 4.1±0.8mm, p<0.001) and in Non-ETM group (2.3±0.3 vs 4.1±1.3 mm, p<0.001), respectively. The rising speed of temperature was faster in patients with EI than those without EI (7.6±5.6 vs 10.7±6.2 sec, p=0.025). Maximum arrival temperature of esophagus was higher in patients with EI than those without EI (42.4±5.7 vs 41.2±1.5, p=0.038).Receiver operating characteristic curves were constructed to assess the ability of SD-CT and esophageal temperature to predict EI. Conclusions: The use of ETM is safe and necessary in order to prevent the occurrence of EI. The incidence of EI was correlated with SD-CT. ETM reduced EI, especially in patients with short SD-CT.