| Identification of a high-risk population for esophageal injury during radiofrequency catheter ablation of atrial fibrillation: procedural and anatomical considerations. | |
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MedLine Citation:
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PMID: 20188859 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Atrioesophageal fistula is an uncommon but life-threatening complication of atrial fibrillation (AF) ablation. Esophageal ulcerations (ESUL) have been proposed to be potential precursor lesions. OBJECTIVE: The purpose of our study was to prospectively investigate the incidence of ESUL in a large patient population undergoing radiofrequency catheter ablation (RFA). Additionally, we aimed to link demographic data and lesion sets with anatomical information given by multislice computed tomography imaging and to correlate these data with the development of ESUL. METHODS: This study included 267 patients and consecutively screened all individuals for evidence of ESUL 24 h after RFA of AF by endoscopy of the esophagus. A standardized ablation approach using a 25-W energy maximum at the posterior left atrial (LA) wall without esophagus visualization, temperature monitoring, or intracardiac ultrasound was performed. RESULTS: In total, we found 2.2% of patients (6 of 267) presenting with ESUL. Parameters exposing a specific patient to risk of developing ESUL in univariate analysis were persistent AF (5 of 95, P = .023), additional lines performed (roofline: 6 of 114, P = .006; LA isthmus: 4 of 49, P = .011; coronary sinus: 5 of 66, P = .004), and LA enlargement (P = .001) leading to sandwiching of the esophagus between the LA and thoracic spine. Multivariate analysis revealed LA-to-esophagus distance as the only significant risk factor. CONCLUSION: This study is the first to link anatomical information and procedural considerations to the development of ESUL in radiofrequency ablation for AF. Furthermore, it reveals the correlation and individual impact of these factors. Not a single patient with pulmonary vein isolation alone developed ESUL. |
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Authors:
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Martin Martinek; Christian Meyer; Said Hassanein; Josef Aichinger; Gabor Bencsik; Rainer Schoefl; Gernot Boehm; Hans-Joachim Nesser; Helmut Purerfellner |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-02-24 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 7 ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-31 Completed Date: 2011-01-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 1224-30 Citation Subset: IM |
Copyright Information:
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Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, Elisabethinen Linz, Academic Teaching Hospital of the Universities of Innsbruck and Graz, Austria. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Fibrillation
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surgery* Endosonography Esophageal Diseases / diagnosis, etiology*, prevention & control Esophagoscopy Esophagus / injuries* Female Follow-Up Studies Humans Intraoperative Complications / diagnosis, etiology*, prevention & control Male Middle Aged Postoperative Care / methods* Prognosis Prospective Studies Risk Factors Tomography, X-Ray Computed Ulcer / diagnosis, etiology*, prevention & control |
| Comments/Corrections | |
Comment In:
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Heart Rhythm. 2010 Sep;7(9):1231-2
[PMID:
20230910
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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