Abstract 18675: Progression of Esophageal Injury after Radiofrequency Catheter Ablation for Atrial Fibrillation.
Introduction: The delivery of radiofrequency energy to left atrial tissue creates a risk for thermal injury to the adjacent esophagus. The spectrum of injury includes tissue hyperemia, ulceration and, rarely, potentially fatal fistulization with the left atrium. Upper endoscopy (EGD) is one of the common methods to screen patients at risk of esophageal injury after radiofrequency ablations, but little is known about the natural history and features of the lesions detected.
Methods: We analyzed the natural history of esophageal tissue injury after radiofrequency ablation to the left atrium. Screening endoscopies were performed in cases in which intra-esophageal temperatures were above 39-Celsius degrees. Patients with esophageal injury were treated with 40 mg bid of omeprazole and their diet changed to ”puree diet” until the subsequent EGD was done. For any degree of tissue injury, serial EGDs at 2 weeks intervals were obtained until healing was documented. The severity of the EGD findings was classified as mild, moderate or severe. Mucosal erythema was considered mild, superficial ulceration was moderate, and deep ulceration was severe.
Results: We analyzed 122 radiofrequency ablation procedures performed at our institution. A screening EGD was performed for those patients with intra-esophageal temperatures greater than 39°C (n=46). The average age was 60±9 years old. Of the initial EGDs, 21.7% (10/46) documented tissue injury. Repeat EGDs were done at 2-week intervals. The average time to healing was 16±6 days, with a minimum of 10 days and maximum of 27 days. Only 3 patients (6.5%) had a time to healing >17 days. A positive correlation was found between the severity of the injury and the time to healing (r = 0.76, p=0.018), with deep ulcerations taking longer to heal.
Conclusions: Visible esophageal tissue injury is common after left atrial ablation procedures which produce a rise in esophageal temperature to greater than 39° Celsius. Most esophageal lesions heal within 1–4 weeks after the ablation procedure, when treated with a proton pump inhibitor and pureed diet. Greater lesion depth is strongly associated with greater delay in healing of esophageal lesions.
- © 2010 by American Heart Association, Inc.