Abstract 2323: Predicting Risk of Esophageal Injury During Atrial Fibrillation Ablation in a Standardized Ablation Approach
Background: Atrio-esophageal fistula is a rare but potentially lethal complication of atrial fibrillation (AF) ablation. The purpose of this study was to develop a risk score for the appearance of esophageal ulcerations (ESUL) following radiofrequency ablation.
Methods: Out of a randomized study protocol including 175 patients (pts) published in JCE 2009 (Martinek M et al.) we identified parameters crucial for ESUL development. From these variables we created a risk score and prospectively tested this scoring system on 222 pts (175 male, 141 paroxysmal AF) with a standardized, stepwise ablation approach (PV isolation, linear ablations, and CFAE), limiting maximum energy to 25W at the posterior wall. All pts underwent esophageal endoscopy 24 hours after ablation to screen for ESUL.
Results: In total we found 1.8% of pts (4/222) presenting ESUL. We identified additional left atrial lines (roofline, inferior/coronary sinus line, left atrial isthmus line) as the only factors predicting ESUL creation in a standardized approach. Pts with a risk score higher than 1 were at increased risk for ESUL [Figure 1⇓].
Conclusions: In this standardized ablation approach including a power limitation to 25W at the posterior wall very few pts develop ESUL compared to other studies. Only pts having more than 1 additional linear ablation performed (risk score higher than 1) are at increased risk for ESUL (4/46; 8.7%). Our risk-score is able to identify pts at highest risk for ESUL which should be examined by esophagogastroscopy after AF ablation.