Abstract
Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature.
Highlights
Catheter ablation has increasingly been performed for the management of atrial fibrillation (AF) as a potentially curative approach[1]
The esophagus is located in close proximity to the posterior left atrium (LA), and ablation in that region may cause damage to the esophagus, resulting in complications such as periesophageal nerve injury, esophageal ulceration or atrioesophageal fistula (AEF)[2,3]
Atrioesophageal fistula is a rare but severe complication related to AF ablation
Summary
Catheter ablation has increasingly been performed for the management of atrial fibrillation (AF) as a potentially curative approach[1]. Since the discovery of the circumferential radiofrequency (RF) ablation technique, with antral pulmonary vein isolation, there have been many improvements to make the procedure safer and effective. Considered a minimally invasive procedure, some complications are reported. The esophagus is located in close proximity to the posterior left atrium (LA), and ablation in that region may cause damage to the esophagus, resulting in complications such as periesophageal nerve injury, esophageal ulceration or atrioesophageal fistula (AEF)[2,3]. Atrioesophageal fistula is a rare but severe complication related to AF ablation. Esophageal injury (perforation or fistula) is described as occurring in approximately 0.5% of all AF ablation procedures[4]
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