Surveillance of esophageal injury after atrial fibrillation catheter ablation

Alberto Pereira Ferraz; Cristiano Faria Pisani; Esteban Wisnivesky Rocca Rivarola; Tan Chen Wu; Francisco Carlos da Costa Darrieux; Rafael Alvarenga Scanavacca; Carina Abigail Hardy; Muhieddine Omar Chokr; Denise Tessariol Hachul; Maurício Ibrahim Scanavacca

doi:10.1007/s10840-024-01922-8

Surveillance of esophageal injury after atrial fibrillation catheter ablation

J Interv Card Electrophysiol. 2024 Oct 22. doi: 10.1007/s10840-024-01922-8. Online ahead of print.

Affiliations

¹ University of São Paulo Medical School, Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil. albertopferraz@gmail.com.
² University of São Paulo Medical School, Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil.

PMID: 39436462
DOI: 10.1007/s10840-024-01922-8

Abstract

Aims: Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.

Methods: This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.

Results: A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.

Conclusion: The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.

Keywords: Atrial fibrillation ablation; Atrial-esophageal fistula; Endoscopy; Screening.