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Circulation: Arrhythmia and Electrophysiology
This retrospective study analyzed patients undergoing atrial fibrillation ablation and postprocedural esophageal endoscopy to better understand the association of thermal esophageal lesions with clinical complications. The study found that 10% of patients with postablation esophageal ulcers progressed to perforation, whereas patients without esophageal ulcers did not progress to perforations. Ulcers were significantly predictive of perforations.
Progression From Esophageal Thermal Asymptomatic Lesion to Perforation Complicating Atrial Fibrillation Ablation
A Single-Center Registry
Philipp Halbfass, MD
Borche Pavlov, MD
Patrick Müller, MD
Karin Nentwich, MD
Kai Sonne, MD
Sebastian Barth, MD
Karsten Hamm, MD
Franziska Fochler, MD
Andreas Mügge, MD
Ulrich Lüsebrink, MD
Rainer Kuhn, MD
Thomas Deneke, MD
Correspondence to: Philipp Halbfass, MD, Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale 97616, Germany. E-mail firstname.lastname@example.org
BACKGROUND: Up to 40% of patients demonstrate endoscopically detected asymptomatic esophageal lesions (EDEL) after atrial fibrillation ablation.
METHODS AND RESULTS: Patients undergoing first atrial fibrillation ablation and postinterventional esophageal endoscopy were included in the study. Occurrence of esophageal perforating complications during follow-up was related to documented EDEL (category 1: erythema/erosion; category 2: ulcer). In total, 1802 patients underwent first atrial fibrillation ablation procedure between January 2013 and August 2016 at our institution. Out of this group, 832 patients (506 male patients, 61%; 64.0±10.0 years) with symptomatic paroxysmal (n=345; 42%) or persistent atrial fibrillation underwent postprocedural esophageal endoscopy. Patients were ablated using single-tip ablation with conventional or surround flow irrigation and circular ablation catheters with open irrigation (nMARQ). In 295 of 832 patients (35%), a temperature probe was used. EDEL occurred in 150 patients (18%; n=98 category 1 EDEL, n=52 category 2 EDEL). In 5 of 832 patients (0.6%), an esophageal perforation (n=3) or an esophagopericardial or atrioesophageal fistula (n=2) occurred 15 to 28 days (19±6 days) after ablation. Two patients (1 atrioesophageal fistula and 1 esophagopericardial fistula) died. Esophageal perforation occurred only in patients with category 2 …