Bharath Yarlagadda1, Thomas Deneke2, Mohit Turagam3, Tawseef Dar1, Swathi Paleti4, Valay Parikh1, Luigi DiBiase5, Philipp Halfbass6, Pasquale Santangeli7, Srijoy Mahapatra8, Jie Cheng9, Andrea Russo10, James Edgerton11, Moussa Mansour12, Jeremy Ruskin12, Srinivas Dukkipati3, David Wilber13, Vivek Reddy3, Douglas Packer14, Andrea Natale15, Dhanunjaya Lakkireddy16. 1. Division of Electrophysiology, University of Kansas Medical Center, Kansas City, Kansas. 2. Department of Cardiology and Angiology, Philipps University Marburg, Marburg, Germany. 3. Division of Electrophysiology, Icahn School of Medicine, New York, New York. 4. Division of Gastroenterology, University of New Mexico, Albuquerque, New Mexico. 5. Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York. 6. Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany. 7. Division of Electrophysiology, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Abbott Medical, Chicago, Illinois. 9. Memorial Hermann Medical Center, Houston, Texas. 10. Division of Electrophysiology, Cooper University Hospital, Cherry Hill, New Jersey. 11. Center for Advanced Cardiovascular Care, Baylor Health, Plano, Texas. 12. Division of Electrophysiology, Mass General Hospital, Boston, Massachusetts. 13. Division of Electrophysiology, Loyola Medical Center, Chicago, Illinois. 14. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 15. St. David's - Texas Cardiac Arrhythmia Institute, Austin, Texas. 16. Kansas City Heart Rhythm Institute, Overland Park, Kansas. Electronic address: dhanunjaya.lakkireddy@hcahealthcare.com.
Abstract
BACKGROUND: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. OBJECTIVES: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. METHODS: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. RESULTS: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. CONCLUSION: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.
BACKGROUND: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. OBJECTIVES: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. METHODS: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablationpatients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. RESULTS: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. CONCLUSION: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.
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: René Worck; Samuel K Sørensen; Arne Johannessen; Martin Ruwald; Martin Haugdal; Jim Hansen Journal: J Cardiovasc Electrophysiol Date: 2022-05-31 Impact factor: 2.942
Authors: Timothy Richard Maher; João Vítor Ternes Rech; Caique Martins Pereira Ternes; Alexander Dal Forno; André D'Avila Journal: J Innov Card Rhythm Manag Date: 2022-09-15
Authors: Lisa W M Leung; Abhay Bajpai; Zia Zuberi; Anthony Li; Mark Norman; Riyaz A Kaba; Zaki Akhtar; Banu Evranos; Hanney Gonna; Idris Harding; Manav Sohal; Nawaf Al-Subaie; John Louis-Auguste; Jamal Hayat; Mark M Gallagher Journal: Europace Date: 2021-02-05 Impact factor: 5.214