Abstract 17429: The Predictors of Esophageal Lesions After Radiofrequency Catheter Ablation for Pulmonary Vein Isolation
Introduction: The esophageal injury after pulmonary vein isolation (PVI) caused occasionally serious complication. However, the relation between esophageal injury and local esophageal temperature at radiofrequency (RF) application was unclear.
Hypothesis: The esophageal injury may be related to an increase of temperature and contact force at local ablation site.
Methods: We retrospectively investigated consecutive 124 patients who were received PVI for atrial fibrillation by RF energy from May 2014 to February 2016. They were received upper gastrointestinal endoscopy (GS) and checked esophageal lesions two days after ablation. The definition of esophageal lesions after ablation were decided more than one features (reddish, furred, erosion or ulceration) at both esophageal anterior and posterior wall.
Results: In 124 patients,the usage of oral anticoagulation was warfarin (23 patients), dabigatran (51 patients), rivaroxaban (3 patients) and apixaban (47 patients). The Seventeen patients (13.7%) were pointed out esophageal lesions by GS after ablation. The details of findings were as follow: 9 (7.3%) were reddish, 11 (8.9%) were furred and 10 (8.1%) were erosion. Ten patients had over two features. Nobody had esophageal ulceration. The patients with esophageal lesions were wholly taken non-vitamin K oral anticoagulants (NOAC) (p=0.040). The patients used dabigatran had a tendency to have many esophageal lesions (13 patients: 25.5%), but no significant differences. Moreover, these patients were severe spontaneous echo contrast (SEC) by transesophageal echocardiography (38.5% vs 10.8%, p=0.017), lower estimated GFR (59.2+/-7.6ml/min/1.73m2 vs 65.9+/-11.7ml/min/1.73m2, p=0.023) than the patient without lesions. On the other hand, urine anti-pylori antibody test was examined for 58 consecutive patients and 20 (34.5%) were judged positive. The ratio of H.pylori positive was more in esophageal lesions group (25.0% vs 5.3%, p=0.041). However, no significant differences were seen by the times of elevated esophageal temperature, contact force and total RF delivery time.
Conclusions: Usage of NOAC, severe SEC, lower estimated GFR and urine anti-pylori antibody test positive may be the predictor of esophageal lesions after RF ablation.
Author Disclosures: R. Takeuchi: None. A. Nakajima: None. H. Mitake: None. M. Omote: None. K. Kodama: None. N. Hosoya: None. S. Kageyama: None. Y. Watanabe: None. H. Sugiyama: None. K. Murata: None. R. Nawada: None. T. Onodera: None. T. Oyaizu: None.
- © 2016 by American Heart Association, Inc.