Published online before print May 24, 2004, doi: 10.1161/01.CIR.0000131866.44650.46
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(Circulation. 2004;109:2724-2726.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial Fibrillation
From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
Correspondence to Carlo Pappone, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone{at}hsr.it
Received March 19, 2004; revision received April 20, 2004; accepted April 27, 2004.
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Abstract |
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 Top Abstract IntroductionMethodsDiscussionReferences |
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Background— Radiofrequency ablation for atrial fibrillation is becoming widely practiced.
Methods and Results— Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients.
Conclusions— Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
Key Words: arrhythmia • ablation • surgery • fistula
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Introduction |
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TopAbstractIntroductionMethodsDiscussionReferences |
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Catheter ablation of atrial fibrillation (AF) has become an important therapy in recent years. As with all evolving techniques, unexpected complications may occur. This article describes 2 cases of atrio-esophageal fistula that occurred at 2 centers shortly after percutaneous circumferential pulmonary vein ablation (CPVA).
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Methods |
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TopAbstractIntroductionMethodsDiscussionReferences |
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The ablation procedure has been described in detail elsewhere.1–3 Briefly, reconstructions of the left atrium (LA) and pulmonary vein (PV) ostia are created with a 3D mapping system. Radiofrequency energy is delivered with an 8-mm-tip catheter (Navistar, Biosense Webster) in a circumferential fashion, 1 to 2 cm from the left- and right-sided PVs, to result in voltage abatement inside the encircling ablation lines. Ablation lines are also created on the posterior wall between the circumferential lesions and between the left inferior PV and mitral valve. In addition, when individual veins arise from separate ostia, an ablation line sometimes is created between the ipsilateral PVs.
Case 1
A 36-year-old man with drug-refractory chronic AF underwent CPVA in January 2004 in Milan, Italy (Figure 1, left). LA diameter was 33 mm, and left ventricular ejection fraction was 55%. The procedure was well tolerated and uneventful. Radiofrequency generator settings were standard for the laboratory, with a temperature limit of 60°C and a maximum power output of 100 W. There were no instances of tissue carbonization, and the catheter was free of thrombus at the end of the procedure. The patient was discharged the following day. Medications at the time of discharge consisted of calciparin, warfarin, irbesartan, amiodarone, and digoxin.
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On the third postprocedural day, the patient presented to his local hospital with fever, pleuritic chest pain, grossly elevated white cell count and inflammatory markers, and convulsions. Cerebral CT showed signs of patchy bilateral ischemia and infarction. Transthoracic echocardiography (TTE) did not show any evidence of vegetations, and therapy with intravenous antibiotics was begun. On day 12, the patient developed chest pain and anterolateral ST-segment elevation on the ECG. TTE showed gas bubbles in the LA. Coronary angiography showed occlusion of the left anterior descending artery, which was subsequently stented. The patient lost consciousness and developed left-sided hemiparesis. CT scanning suggested an atrio-esophageal fistula with pneumomediastinum. A head CT demonstrated extensive ischemic changes consistent with cerebral air emboli.
The patient underwent emergency surgery. Cardiopulmonary bypass was instituted, and through a standard left atriotomy, a 1-cm laceration in the posterior wall of the LA was visible immediately medial to the left PV ostia (Figure 2, left). There were no overlying vegetations. The laceration was repaired with pledgeted sutures and a bovine pericardial patch. The esophagus was isolated in the neck with an absorbable purse-string suture. A mediastinal drain was placed adjacent to the lower part of the esophagus, and a feeding gastrostomy was inserted. Continuous mediastinal and pericardial lavage was performed with diluted iodine solution for 5 days. The patient had a stormy postoperative course, complicated by Lactobacillus mediastinitis, which responded to appropriate antibiotic therapy.
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TTE performed on postoperative day 21 showed a left ventricular ejection fraction of 50% and apical hypokinesis. Water-soluble contrast studies showed recanalization of the esophagus, with mild proximal narrowing at the site of the purse-string suture, and a small distal leak of contrast.
Two months after the procedure, the patient was able to eat and drink, but there was residual left hemiparesis. Repeated TTE on postoperative day 54 showed aneurysmal dilatation of the left ventricular apex, with an ejection fraction of 40%.
Case 2
A 59-year-old man with drug-refractory, lone paroxysmal AF and flutter underwent CPVA and ablation in the cavotricuspid isthmus in January 2004 in Ann Arbor, Mich (Figure 1, right). The LA diameter was 29 mm, and ejection fraction was 50%. Radiofrequency generator settings were standard for the laboratory, with a temperature limit of 55°C and a power limit of 70 W. The procedure was uneventful and well tolerated. The patient was discharged from hospital the next day. Medications on discharge consisted of enoxaparin, warfarin, and amiodarone.
Two days after the procedure, the patient developed chest pain and fever. TTE at that time was unremarkable, with no pericardial effusion or evidence of vegetations. He was treated with nonsteroidal antiinflammatory drugs with some improvement in symptoms. Three weeks after the procedure, while in Hawaii, he had rapid onset of profound weakness and rigors. He collapsed and was admitted to a local hospital where he had a temperature of 40°C and a grand mal seizure. Cerebral CT was unremarkable. Blood cultures were positive for 
-hemolytic streptococci, micrococcus species, and nonhemolytic streptococci. TTE showed no evidence of valvular or LA vegetations.
Broad-spectrum antibiotic therapy was initiated, and the patient was transferred to a tertiary care hospital. A transesophageal echocardiogram showed a 1.2-cm pedunculated mass on the posterior wall of the LA. He was treated with parenteral vancomycin, cefepime, and gentamicin. Cardiac enzymes confirmed acute myocardial infarction, although his ECG showed only nonspecific ST-T–wave abnormalities.
Circulatory collapse, respiratory failure, and coma developed, requiring inotropic support and ventilation. Cerebral CT showed widespread ischemic changes consistent with multiple emboli. His condition steadily deteriorated, and the family decided to withdraw life support, shortly after which he died.
Cardiopulmonary postmortem examination demonstrated an atrio-esophageal fistula on the posterior wall of the LA, near the left superior PV, with adherent vegetation (Figure 2). Cultures were sterile, but microscopic examination showed granulation tissue and Gram-positive cocci. There were multiple areas of myocardial infarction consistent with septic coronary embolization.
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Discussion |
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TopAbstractIntroductionMethodsDiscussionReferences |
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Atrio-esophageal fistula is a recognized complication of intraoperative radiofrequency ablation of AF, with an incidence reported to be as high as 1%.4 Our cases demonstrate that this complication may also result from percutaneous radiofrequency catheter ablation in the LA.
The CPVA technique used in these patients has been performed in a combined total of 4360 patients in the 2 laboratories, yielding a prevalence of 0.05%. Therefore, the risk of an atrio-esophageal fistula with this technique appears to be very low. Nonetheless, because atrio-esophageal fistulas have devastating consequences and are often fatal, all possible measures must be taken to avoid this complication.
Clinical Presentation
These cases share similarities. Both patients developed clinical features of pericarditis 2 to 3 days after the procedure, with TTE being unremarkable. Both patients subsequently developed fever and convulsions. Multiple cardiac and cerebral emboli characterized the latter phase of the process. Massive hematemesis has been reported in prior studies but was absent in both patients in this report, suggesting that the fistulas may have been covered by a 1-way valve. The atrial dimensions of both patients were relatively small, and it is possible that this predisposed them to fistula formation.
Diagnosis
Endocarditis should be excluded in any patient presenting after a catheter ablation procedure with fever, pericarditis-type chest pain, or signs or symptoms of systemic embolization. A registry of >3000 ablation procedures did not document a single case of endocarditis5; however, there are isolated case reports of endocarditis occurring at sites of previous ablation.6,7 In our cases, the fistula acted as the point of entry for organisms from the upper gastrointestinal tract.
Patients who have undergone catheter ablation along the posterior aspect of the LA presenting with a clinical picture of endocarditis should have an atrio-esophageal fistula excluded. Transesophageal echocardiogram should be avoided because, if a fistula is present, instrumentation of the esophagus may cause rapid deterioration and even death, as highlighted in previous surgical cases.8,9 Similarly, esophagoscopy is contraindicated because gas insufflation may result in massive air embolism and/or barotrauma to the damaged tissue, resulting in massive hemorrhage. Noninvasive imaging such as MRI, TTE, or CT is preferable. Thoracic CT scan with water-soluble contrast appears to be particularly helpful for identifying the fistula and pneumomediastinum.
Management
Antimicrobial therapy alone appears not to improve the situation, and widespread gaseous or septic embolization will continue without prompt surgical intervention. Definitive treatment should be expedited once the diagnosis has been confirmed because rapid deterioration and death are likely.
Prevention
Radiofrequency generator settings and lesion sets for AF ablation have evolved through experience, reaching a point at which the procedure can now be safely performed in a relatively short period of time with success rates of between 80% and 90%.1–3
LA wall thickness varies considerably, averaging 
4 mm in the true LA but decreasing to 2.5 mm at the VA junctions.10 In both patients, the fistulas occurred in a region where ablation lines overlap, particularly in small atria (Figure 1). Previous reports of atrio-esophageal fistulas after intraoperative radiofrequency ablation of AF suggested that overlapping lines in the posterior wall may have been responsible for esophageal injury.9
Reversible thermal injury of the esophagus has been reported after ingestion of hot liquids or solids,11 and it is possible that subclinical thermal injury to the esophagus during LA ablation may go recognized. Further studies are required to monitor temperature changes in the esophagus during the creation of lesions. We recommend that lower generator settings of 50 W and 55°C be used during ablation in the posterior wall to avoid excessively deep lesions and subsequent esophageal injury. In addition, the transverse posterior line should be placed at the roof, where the atrium tends to be thicker and is not in direct contact with the esophagus.
Conclusions
Catheter ablation along the posterior aspect of the LA is associated with a small but real risk of atrio-esophageal fistula. Rapid diagnosis and surgical therapy may prevent death. We hope that minimizing the amount of ablation along the posterior aspect of the LA and decreasing the power of radiofrequency energy applications will avoid any further instances of atrio-esophageal fistulas.
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References |
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TopAbstractIntroductionMethodsDiscussionReferences |
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1. Pappone C, Rosanio S, Augello G, et al. Mortality, morbidity and quality of life after circumferential pulmonary vein ablation for atrial fibrillation. J Am Coll Cardiol. 2003; 42: 185–197.
2. Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation. 2003; 108: 2355–2360.
3. Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential pulmonary vein ablation for atrial fibrillation. Circulation. 2004; 109: 327–334.
4. Doll N, Borger M, Fabricius A, et al. Esophageal perforation during left atrial radiofrequency ablation: is the risk too high? J Thorac Cardiovasc Surg. 2003; 125: 836–842.
5. Scheinman M, Huang S. The 1998 NASPE Prospective Catheter Ablation Registry. Pacing Clin Electrophysiol. 2000; 23: 1020–1028.[CrossRef][Medline] [Order article via Infotrieve]
6. Benito Bartolome F, Sanchez Fernandez-Bernal C. Infectious mitral endocarditis after radiofrequency catheter ablation of a left-lateral accessory pathway. Rev Esp Cardiol. 2001; 54: 999–1001.[Medline] [Order article via Infotrieve]
7. Song M, Usui M, Watanabe T, et al. Giant vegetation mimicking cardiac tumour in tricuspid valve endocarditis after catheter ablation. Jpn J Thorac Cardiovasc Surg. 2001; 49: 255–257.[Medline] [Order article via Infotrieve]
8. Gillinov A, Pettersson, Rice T. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg. 2001; 122: 1239–1240.
9. Sonmez B, Demirsoy E, Yagan N, et al. A fatal complication due to radiofrequency ablation for atrial fibrillation: atrio-esophageal fistula. Ann Thorac Surg. 2003; 76: 281–283.
10. Ho S, Sanchez-Quintana D, Cabrera J, et al. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 1999; 10: 1525–1533.[Medline] [Order article via Infotrieve]
11. Dutta S, Chung K, Bhagavan B. Thermal injury of the esophagus. N Engl J Med. 1998; 339: 480–481.
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H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]
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J.-Y. Kuo and S.-A. Chen Is Vagal Denervation a Good Alternative or Just Adjunctive to Pulmonary Vein Isolation in Catheter Ablation of Atrial Fibrillation? J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1349 - 1351. [Full Text] [PDF]
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O. M. Wazni, H.-M. Tsao, S.-A. Chen, H.-H. Chuang, W. Saliba, A. Natale, and A. L. Klein Cardiovascular Imaging in the Management of Atrial Fibrillation J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2077 - 2084. [Abstract] [Full Text] [PDF]
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S. Dey, E. Good, F. Morady, and H. Oral Esophageal Diverticulum Illustrated by Barium Swallow During Left Atrial Catheter Ablation for Atrial Fibrillation Circulation, November 21, 2006; 114(21): e597 - e597. [Full Text] [PDF]
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Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
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V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]
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V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
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V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
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V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]
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L. J. Gula, A. C. Skanes, E. Posan, A. D. Krahn, R. Yee, and G. J. Klein Gastroesophageal Reflux Facilitates Esophageal Imaging During Pulmonary Vein Ablation Circulation, August 8, 2006; 114(6): e235 - e236. [Full Text] [PDF]
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Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]
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I. Deisenhofer, H. Estner, B. Zrenner, J. Schreieck, S. Weyerbrock, G. Hessling, K. Scharf, M. R. Karch, and C. Schmitt Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation. Europace, August 1, 2006; 8(8): 573 - 582. [Abstract] [Full Text] [PDF]
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F. Sacher, K. H. Monahan, S. P. Thomas, N. Davidson, P. Adragao, P. Sanders, M. Hocini, Y. Takahashi, M. Rotter, T. Rostock, et al. Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation: Characterization and Outcome in a Multicenter Study J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2498 - 2503. [Abstract] [Full Text] [PDF]
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T. J. Bunch, S. Mahapatra, G. K. Bruce, S. B. Johnson, D. V. Miller, B. D. Horne, X.-L. Wang, H.-C. Lee, N. M. Caplice, and D. L. Packer Impact of Transforming Growth Factor-{beta}1 on Atrioventricular Node Conduction Modification by Injected Autologous Fibroblasts in the Canine Heart Circulation, May 30, 2006; 113(21): 2485 - 2494. [Abstract] [Full Text] [PDF]
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H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]
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C. Pappone, G. Vicedomini, F. Manguso, F. Gugliotta, P. Mazzone, S. Gulletta, N. Sora, S. Sala, A. Marzi, G. Augello, et al. Robotic Magnetic Navigation for Atrial Fibrillation Ablation J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1390 - 1400. [Abstract] [Full Text] [PDF]
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P. Schley, H. Gulker, and M. Horlitz Atrio-oesophageal fistula following circumferential pulmonary vein ablation: verification of diagnosis with multislice computed tomography. Europace, March 1, 2006; 8(3): 189 - 190. [Full Text] [PDF]
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A. Chugh, R. Latchamsetty, H. Oral, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, T. Lemerand, E. Good, F. Bogun, et al. Characteristics of Cavotricuspid Isthmus-Dependent Atrial Flutter After Left Atrial Ablation of Atrial Fibrillation Circulation, February 7, 2006; 113(5): 609 - 615. [Abstract] [Full Text] [PDF]
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P. Kotini, S. Mohler, K. A. Ellenbogen, and M. A. Wood Detection of microbubble formation during radiofrequency ablation using phonocardiography. Europace, January 1, 2006; 8(5): 333 - 335. [Abstract] [Full Text] [PDF]
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M. Hocini, P. Jais, P. Sanders, Y. Takahashi, M. Rotter, T. Rostock, L.-F. Hsu, F. Sacher, S. Reuter, J. Clementy, et al. Techniques, Evaluation, and Consequences of Linear Block at the Left Atrial Roof in Paroxysmal Atrial Fibrillation: A Prospective Randomized Study Circulation, December 13, 2005; 112(24): 3688 - 3696. [Abstract] [Full Text] [PDF]
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E. Good, H. Oral, K. Lemola, J. Han, K. Tamirisa, P. Igic, D. Elmouchi, D. Tschopp, S. Reich, A. Chugh, et al. Movement of the Esophagus During Left Atrial Catheter Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2107 - 2110. [Abstract] [Full Text] [PDF]
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H. Aupperle, N. Doll, T. Walther, P. Kornherr, C. Ullmann, H.-A. Schoon, and F. W. Mohr Ablation of atrial fibrillation and esophageal injury: Effects of energy source and ablation technique J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1549 - 1554. [Abstract] [Full Text] [PDF]
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V. Essebag, F. Baldessin, M. R. Reynolds, S. McClennen, J. Shah, K. F. Kwaku, P. Zimetbaum, and M. E. Josephson Non-inducibility post-pulmonary vein isolation achieving exit block predicts freedom from atrial fibrillation Eur. Heart J., December 1, 2005; 26(23): 2550 - 2555. [Abstract] [Full Text] [PDF]
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F R Quinn and A C Rankin Atrial fibrillation ablation in the real world Heart, December 1, 2005; 91(12): 1507 - 1508. [Abstract] [Full Text] [PDF]
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A. V. Sarabanda, T. J. Bunch, S. B. Johnson, S. Mahapatra, M. A. Milton, L. R. Leite, G. K. Bruce, and D. L. Packer Efficacy and Safety of Circumferential Pulmonary Vein Isolation Using a Novel Cryothermal Balloon Ablation System J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1902 - 1912. [Abstract] [Full Text] [PDF]
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F. Ouyang, S. Ernst, J. Chun, D. Bansch, Y. Li, A. Schaumann, H. Mavrakis, X. Liu, F. T. Deger, B. Schmidt, et al. Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique Circulation, November 15, 2005; 112(20): 3038 - 3048. [Abstract] [Full Text] [PDF]
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H.-M. Tsao, M.-H. Wu, S. Higa, K.-T. Lee, C.-T. Tai, N.-W. Hsu, C.-Y. Chang, and S.-A. Chen Anatomic Relationship of the Esophagus and Left Atrium: Implication for Catheter Ablation of Atrial Fibrillation Chest, October 1, 2005; 128(4): 2581 - 2587. [Abstract] [Full Text] [PDF]
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K. Lemola, H. Oral, A. Chugh, B. Hall, P. Cheung, J. Han, K. Tamirisa, E. Good, F. Bogun, F. Pelosi Jr, et al. Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1060 - 1066. [Abstract] [Full Text] [PDF]
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D. Sanchez-Quintana, J. A. Cabrera, V. Climent, J. Farre, M. C. de Mendonca, and S. Y. Ho Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation Circulation, September 6, 2005; 112(10): 1400 - 1405. [Abstract] [Full Text] [PDF]
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R. K. Wolf, E. W. Schneeberger, R. Osterday, D. Miller, W. Merrill, J. B. Flege Jr, and A. M. Gillinov Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 797 - 802. [Abstract] [Full Text] [PDF]
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T. Deneke, K. Khargi, K.-M. Muller, B. Lemke, A. Mugge, A. Laczkovics, A. E. Becker, and P. H. Grewe Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation Eur. Heart J., September 1, 2005; 26(17): 1797 - 1803. [Abstract] [Full Text] [PDF]
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A. Verma, A. Natale, B. J. Padanilam, E. N. Prystowsky, A. Verma, A. Natale, B. J. Padanilam, and E. N. Prystowsky Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients Circulation, August 23, 2005; 112(8): 1214 - 1222. [Full Text] [PDF]
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B. J. Padanilam and E. N. Prystowsky Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position Circulation, August 23, 2005; 112(8): 1223 - 1231. [Full Text] [PDF]
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G. K. Bruce, T. J. Bunch, M. A. Milton, A. Sarabanda, S. B. Johnson, and D. L. Packer Discrepancies Between Catheter Tip and Tissue Temperature in Cooled-Tip Ablation: Relevance to Guiding Left Atrial Ablation Circulation, August 16, 2005; 112(7): 954 - 960. [Abstract] [Full Text] [PDF]
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J. E. Cummings, R. A. Schweikert, W. I. Saliba, J. D. Burkhardt, J. Brachmann, J. Gunther, V. Schibgilla, A. Verma, M. Dery, J. L. Drago, et al. Assessment of Temperature, Proximity, and Course of the Esophagus During Radiofrequency Ablation Within the Left Atrium Circulation, July 26, 2005; 112(4): 459 - 464. [Abstract] [Full Text] [PDF]
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D. Shah, J.-M. Dumonceau, H. Burri, H. Sunthorn, A. Schroft, P. Gentil-Baron, Y. Yokoyama, and A. Takahashi Acute Pyloric Spasm and Gastric Hypomotility: An Extracardiac Adverse Effect of Percutaneous Radiofrequency Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 19, 2005; 46(2): 327 - 330. [Abstract] [Full Text] [PDF]
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A. Chugh, H. Oral, E. Good, J. Han, K. Tamirisa, K. Lemola, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, et al. Catheter Ablation of Atypical Atrial Flutter and Atrial Tachycardia Within the Coronary Sinus After Left Atrial Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 5, 2005; 46(1): 83 - 91. [Abstract] [Full Text] [PDF]
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P. Zimetbaum An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation Circulation, June 14, 2005; 111(23): 3150 - 3156. [Full Text] [PDF]
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