Document Detail


Identification of a high-risk population for esophageal injury during radiofrequency catheter ablation of atrial fibrillation: procedural and anatomical considerations.
MedLine Citation:
PMID:  20188859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Comparative Study; Journal Article     Date:  2010-02-24
Journal Detail:
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:
Created Date:  2010-08-31     Completed Date:  2011-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1224-30     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Elisabethinen Linz, Academic Teaching Hospital of the Universities of Innsbruck and Graz, Austria.
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / 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:
Heart Rhythm. 2010 Sep;7(9):1231-2   [PMID:  20230910 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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