Philipp Halbfass1, Borche Pavlov2, Patrick Müller2, Karin Nentwich2, Kai Sonne2, Sebastian Barth2, Karsten Hamm2, Franziska Fochler2, Andreas Mügge2, Ulrich Lüsebrink2, Rainer Kuhn2, Thomas Deneke2. 1. From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology Bad Neustadt an der Saale, Germany (R.K.). philipp.halbfass@kardiologie-bad-neustadt.de. 2. From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology Bad Neustadt an der Saale, Germany (R.K.).
Abstract
BACKGROUND: Up to 40% of patients demonstrate endoscopically detected asymptomatic esophageal lesions (EDEL) after atrial fibrillation ablation. METHODS AND RESULTS: Patients undergoing first atrial fibrillation ablation and postinterventional esophageal endoscopy were included in the study. Occurrence of esophageal perforating complications during follow-up was related to documented EDEL (category 1: erythema/erosion; category 2: ulcer). In total, 1802 patients underwent first atrial fibrillation ablation procedure between January 2013 and August 2016 at our institution. Out of this group, 832 patients (506 male patients, 61%; 64.0±10.0 years) with symptomatic paroxysmal (n=345; 42%) or persistent atrial fibrillation underwent postprocedural esophageal endoscopy. Patients were ablated using single-tip ablation with conventional or surround flow irrigation and circular ablation catheters with open irrigation (nMARQ). In 295 of 832 patients (35%), a temperature probe was used. EDEL occurred in 150 patients (18%; n=98 category 1 EDEL, n=52 category 2 EDEL). In 5 of 832 patients (0.6%), an esophageal perforation (n=3) or an esophagopericardial or atrioesophageal fistula (n=2) occurred 15 to 28 days (19±6 days) after ablation. Two patients (1 atrioesophageal fistula and 1 esophagopericardial fistula) died. Esophageal perforation occurred only in patients with category 2 lesions (absolute risk, 9.6%). In a logistic regression analysis, ulcers were identified to be a significant predictor for esophageal perforating complications. CONCLUSIONS: Postablation endoscopy seems to identify patients at high risk of esophageal perforating complications only occurring in patients with category 2 EDEL. One out of 10 postablation esophageal ulcers progressed to perforation, and no patient without esophageal thermal ulcers showed the occurrence of perforating esophageal complications.
BACKGROUND: Up to 40% of patients demonstrate endoscopically detected asymptomatic esophageal lesions (EDEL) after atrial fibrillation ablation. METHODS AND RESULTS:Patients undergoing first atrial fibrillation ablation and postinterventional esophageal endoscopy were included in the study. Occurrence of esophageal perforating complications during follow-up was related to documented EDEL (category 1: erythema/erosion; category 2: ulcer). In total, 1802 patients underwent first atrial fibrillation ablation procedure between January 2013 and August 2016 at our institution. Out of this group, 832 patients (506 male patients, 61%; 64.0±10.0 years) with symptomatic paroxysmal (n=345; 42%) or persistent atrial fibrillation underwent postprocedural esophageal endoscopy. Patients were ablated using single-tip ablation with conventional or surround flow irrigation and circular ablation catheters with open irrigation (nMARQ). In 295 of 832 patients (35%), a temperature probe was used. EDEL occurred in 150 patients (18%; n=98 category 1 EDEL, n=52 category 2 EDEL). In 5 of 832 patients (0.6%), an esophageal perforation (n=3) or an esophagopericardial or atrioesophageal fistula (n=2) occurred 15 to 28 days (19±6 days) after ablation. Two patients (1 atrioesophageal fistula and 1 esophagopericardial fistula) died. Esophageal perforation occurred only in patients with category 2 lesions (absolute risk, 9.6%). In a logistic regression analysis, ulcers were identified to be a significant predictor for esophageal perforating complications. CONCLUSIONS: Postablation endoscopy seems to identify patients at high risk of esophageal perforating complications only occurring in patients with category 2 EDEL. One out of 10 postablation esophageal ulcers progressed to perforation, and no patient without esophageal thermal ulcers showed the occurrence of perforating esophageal complications.
Authors: Yuki Ishidoya; Eugene Kwan; Derek J Dosdall; Rob S Macleod; Leenhapong Navaravong; Benjamin A Steinberg; T Jared Bunch; Ravi Ranjan Journal: J Cardiovasc Electrophysiol Date: 2022-06-03 Impact factor: 2.942
Authors: Yuki Ishidoya; Eugene Kwan; Derek J Dosdall; Rob S Macleod; Leenhapong Navaravong; Benjamin A Steinberg; T Jared Bunch; Ravi Ranjan Journal: J Cardiovasc Electrophysiol Date: 2022-06-07 Impact factor: 2.942
Authors: Sergio Castrejón-Castrejón; Marcel Martínez Cossiani; Marta Ortega Molina; Carlos Escobar; Consuelo Froilán Torres; Nerea Gonzalo Bada; Marta Díaz de la Torre; José Manuel Suárez Parga; José Luis López Sendón; José Luis Merino Journal: J Interv Card Electrophysiol Date: 2019-11-12 Impact factor: 1.900
Authors: Ka H C Li; Mei Dong; Mengqi Gong; George Bazoukis; Ishan Lakhani; Yan Y Ting; Sunny H Wong; Guangping Li; William K K Wu; Vassilios S Vassiliou; Martin C S Wong; Konstantinos Letsas; Yimei Du; Victoria Laxton; Bryan P Yan; Yat S Chan; Yunlong Xia; Tong Liu; Gary Tse Journal: Front Physiol Date: 2018-05-22 Impact factor: 4.566