Chirag R Barbhaiya1, Saurabh Kumar2, Yu Guo3, Judy Zhong3, Roy M John2, Usha B Tedrow2, Bruce A Koplan2, Laurence M Epstein4, William G Stevenson2, Gregory F Michaud4. 1. Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York, USA. Electronic address: chirag.barbhaiya@nyumc.org. 2. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. 3. Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA. 4. Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York, USA.
Abstract
OBJECTIVES: This study sought to assess the incidence, operator demographics, clinical characteristics, procedural factors, and prognosis of esophageal perforation and fistula after atrial fibrillation ablation. BACKGROUND: Esophageal injury is a feared complication of atrial fibrillation ablation. METHODS: An Internet-based global survey soliciting anonymous information regarding esophageal perforation and fistula was emailed to 3,080 physicians. Detailed information regarding physician, patient, and procedural characteristics related to esophageal perforation with or without fistula was collected. RESULTS: The survey was completed by 405 of 3,080 physicians (13%). Responding physicians performed 191,215 atrial fibrillation ablations and esophageal perforation with or without fistula occurred in 31 patients (0.016%) with multiple ablation catheter types despite monitoring of esophageal position or temperature during ablation in 90% of patients. Among patients who present with esophageal perforation, death, or severe neurologic injury occurred more frequently in patients with greater body mass index (30.9 ± 6.8 kg/m2 vs. 25.8 ± 3.3 kg/m2; p = 0.03), and lower left ventricular ejection fraction (55.1 ± 9.1% vs. 61.7 ± 5.4%; p = 0.04). Among analyzed patients, atrial-esophageal fistula was seen in 72%, pericardial-esophageal fistula in 14%, and esophageal perforation without fistula in 14%. Mortality was 79% with atrial-esophageal fistula and 13% in esophageal perforation without atrial-esophageal fistula. CONCLUSIONS: Esophageal perforation is rare but continues to occur with multiple catheter types despite esophageal monitoring during ablation. The prognosis of esophageal perforation is substantially improved if diagnosed and treated before development of atrial-esophageal fistula. An early surgical approach to esophageal perforation should be strongly considered regardless of evidence of fistula.
OBJECTIVES: This study sought to assess the incidence, operator demographics, clinical characteristics, procedural factors, and prognosis of esophageal perforation and fistula after atrial fibrillation ablation. BACKGROUND:Esophageal injury is a feared complication of atrial fibrillation ablation. METHODS: An Internet-based global survey soliciting anonymous information regarding esophageal perforation and fistula was emailed to 3,080 physicians. Detailed information regarding physician, patient, and procedural characteristics related to esophageal perforation with or without fistula was collected. RESULTS: The survey was completed by 405 of 3,080 physicians (13%). Responding physicians performed 191,215 atrial fibrillation ablations and esophageal perforation with or without fistula occurred in 31 patients (0.016%) with multiple ablation catheter types despite monitoring of esophageal position or temperature during ablation in 90% of patients. Among patients who present with esophageal perforation, death, or severe neurologic injury occurred more frequently in patients with greater body mass index (30.9 ± 6.8 kg/m2 vs. 25.8 ± 3.3 kg/m2; p = 0.03), and lower left ventricular ejection fraction (55.1 ± 9.1% vs. 61.7 ± 5.4%; p = 0.04). Among analyzed patients, atrial-esophageal fistula was seen in 72%, pericardial-esophageal fistula in 14%, and esophageal perforation without fistula in 14%. Mortality was 79% with atrial-esophageal fistula and 13% in esophageal perforation without atrial-esophageal fistula. CONCLUSIONS: Esophageal perforation is rare but continues to occur with multiple catheter types despite esophageal monitoring during ablation. The prognosis of esophageal perforation is substantially improved if diagnosed and treated before development of atrial-esophageal fistula. An early surgical approach to esophageal perforation should be strongly considered regardless of evidence of fistula.
Authors: Patrick Badertscher; Tarik Delko; Daniel Oertli; Oliver Reuthebuch; Ulrich Schurr; Maurice Pradella; Michael Kühne; Christian Sticherling; Stefan Osswald Journal: Indian Pacing Electrophysiol J Date: 2019-01-24