Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation

Authors

  • Anibal Pires Borges Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0002-3617-9589
  • Guilherme Ferreira Gazzoni Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0001-5019-2475
  • José Plutarco Gutierrez Yanéz Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil.
  • Karina de Andrade Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0002-6127-4617
  • Celine de Oliveira Boff Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0001-8575-4845
  • Flávio Vinícius Costa Ferreira Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0002-7186-707X
  • Eduardo Bartholomay Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil.
  • Álvaro Machado Rösler Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0003-4727-3367
  • Fernando Antonio Lucchese Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil. https://orcid.org/0000-0001-9532-2384
  • Carlos Antonio Kalil Hospital São Francisco – Santa Casa de Misericórdia – Porto Alegre/RS – Brazil.

Keywords:

Atrial fibrillation, Catheter ablation, Esophageal injury, Esophageal temperature monitoring

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.

Downloads

Download data is not yet available.

References

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace. 2018 Jan 1;20(1):157-208.

Scanavacca MI, D’Ávila A, Parga J, Sosa E. Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004 Aug;15(8):960-2.

Pappone C, Oral H, Santinelli V, Vicedomini G, Lang CC, Manguso F, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004 Jun 8;109(22):2724-6.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016 Nov;18(11):1609-1678.

Kapur S, Barbhaiya C, Deneke T, Michaud GF. Esophageal injury and atrioesophageal fistula caused by ablation for atrial fibrillation. Circulation. 2017 Sep 26;136(13):1247-1255.

De Vasconcelos JTM, Filho SDSG, Atié J, Maciel W, De Souza OF, Benchimol Saad E, et al. Atrial-oesophageal fistula following percutaneous radiofrequency catheter ablation of atrial fibrillation: The risk still persists. Europace. 2017 Feb 1;19(2):250-258.

Kadado AJ, Akar JG, Hummel JP. Luminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review. Trends in Cardiovascular Medicine. 2019 Jul;29(5):264-271.

Leung LW, Gallagher MM, Santangeli P, Tschabrunn C, Guerra JM, Campos B, et al. Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2019 Nov 22.

Koneru JN, Kaszala K, Ellenbogen KA. Primum Non Nocere: The Paramount Importance of Esophageal Protection. Circulation: Arrhythmia and Electrophysiology. 2017 Aug;10(8):e005614.

Martinek M, Meyer C, Hassanein S, Aichinger J, Bencsik G, Schoefl R, et al. Identification of a high-risk population for esophageal injury during radiofrequency catheter ablation of atrial fibrillation: Procedural and anatomical considerations. Hear Rhythm. 2010 Sep;7(9):1224-30.

Halbfass P, Pavlov B, Müller P, Nentwich K, Sonne K, Barth S, et al. Progression from Esophageal Thermal Asymptomatic Lesion to Perforation Complicating Atrial Fibrillation Ablation: A Single-Center Registry. Circ Arrhythmia Electrophysiol. 2017 Aug;10(8):e005233.

Ha FJ, Han HC, Sanders P, Teh AW, O’Donnell D, Farouque O, et al. Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: A systematic review and meta-analysis. Europace. 2019 Jan 1;21(1):80-90.

Deneke T, Müller P, Halbfaß P, Szöllösi A, Roos M, Krug J, et al. Effect of Different Ablation Settings on Acute Complications Using the Novel Irrigated Multipolar Radiofrequency Ablation Catheter (nMARQ). J Cardiovasc Electrophysiol. 2015 Oct;26(10):1063-8.

Grubina R, Cha YM, Bell MR, Sinak LJ, Asirvatham SJ. Pneumopericardium following radiofrequency ablation for atrial fibrillation: Insights into the natural history of atrial esophageal fistula formation. J Cardiovasc Electrophysiol. 2010 Sep;21(9):1046-9.

Singh SM, d’Avila A, Doshi SK, Brugge WR, Bedford RA, Mela T, et al. Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circ Arrhythm Electrophysiol. 2008 Aug;1(3):162-8.

Sauer WH, Tzou WS. With Great Power Comes Great Responsibility: Defining the Safety of High-Power Short-Duration Atrial Ablation. Circulation: Arrhythmia and Electrophysiology. 2019 Jun;12(6):e007456.

Baher A, Kheirkhahan M, Rechenmacher SJ, Marashly Q, Kholmovski EG, Siebermair J, et al. High-Power Radiofrequency Catheter Ablation of Atrial Fibrillation: Using Late Gadolinium Enhancement Magnetic Resonance Imaging as a Novel Index of Esophageal Injury. JACC Clin Electrophysiol. 2018 Dec;4(12):1583-1594.

Halbfass P, Berkovitz A, Pavlov B, Sonne K, Nentwich K, Ene E, et al. Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index. J Cardiovasc Electrophysiol. 2019 Nov;30(11):2256-2261.

KochhÄuser S, Alipour P, Haig-Carter T, Trought K, Hache P, Khaykin Y, et al. Risk of Stroke and Recurrence After AF Ablation in Patients With an Initial Event-Free Period of 12 Months. J Cardiovasc Electrophysiol. 2017 Mar;28(3):273-279.

Poole JE, Bahnson TD, Monahan KH, Johnson G, Rostami H, Silverstein AP, et al. Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial. J Am Coll Cardiol. 2020 Jun 30;75(25):3105-3118.

Downloads

Published

18-09-2020

How to Cite

Borges, A., Gazzoni, G., Yanéz, J., Andrade, K., Boff, C., Ferreira, F., Bartholomay, E., Rösler, Álvaro, Lucchese, F., & Kalil, C. (2020). Incidence of Esophageal Thermal Injury Using a Safety Protocol During Atrial Fibrillation Ablation. JOURNAL OF CARDIAC ARRHYTHMIAS, 33(4). Retrieved from https://jca.org.br/jca/article/view/3413

Issue

Section

Electrophysiology

Categories