Atrioesophageal Fistula After Atrial Fibrillation Ablation: A single center series

Khakpour, Houman; Shemin, Richard J.; Lee, Jay M.; Buch, Éric; Boyle, Noel G.; Shivkumar, Kalyanam; Bradfield, Jason S.

doi:10.4022/jafib.1654

Cited by 14 publications

(15 citation statements)

References 37 publications

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“…AEFs are a rare and potentially serious complication of AF catheter ablation with a reported incidence of 0.015 to 0.04%, with the rate thought to be underreported due to low response rates on surveys and misdiagnosis. 53 AEF is the second highest cause of mortality associated with procedural complications, with the mortality rate of 40 to 100% thought to be due to a delay in diagnosing the condition and the complicated surgical procedure required to treat the condition. 53 Even when the condition is identified, patients have a high risk of mortality.…”

Section: Atrioesophageal Fistula Following Catheter Ablation and Its mentioning

confidence: 99%

“…53 AEF is the second highest cause of mortality associated with procedural complications, with the mortality rate of 40 to 100% thought to be due to a delay in diagnosing the condition and the complicated surgical procedure required to treat the condition. 53 Even when the condition is identified, patients have a high risk of mortality. 54 Interestingly, while mucosal changes such as ulcers and erythema can be visualized on esophagogastroduodenoscopy in many cases, in 27% of patients, structural mediastinal changes were only found on endosonography.…”

Section: Atrioesophageal Fistula Following Catheter Ablation and Its mentioning

confidence: 99%

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Treatment Complications of Atrial Fibrillation and Their Management

2020

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Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.

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Section: Atrioesophageal Fistula Following Catheter Ablation and Its mentioning

confidence: 99%

Section: Atrioesophageal Fistula Following Catheter Ablation and Its mentioning

confidence: 99%

Treatment Complications of Atrial Fibrillation and Their Management

2020

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“…Left atrial ablation to perform pulmonary vein isolation (PVI) is increasingly utilized for the treatment of atrial fibrillation 1 . The attainment of PVI can be achieved with radiofrequency (RF) energy to burn atrial tissue or with direct application of cryothermal energy; however, collateral damage to surrounding structures remains a risk with either method, with esophageal injury being one of the most serious 2,3,4 . The most extreme esophageal injury, atrioesophageal fistula (AEF), remains challenging to prevent and diagnose, and carries a very high mortality 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Zagrodzky

Gallagher

Leung

et al. 2020

JoVE

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Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

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“…Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation or cryoablation of the left atrium for the treatment of atrial fibrillation (AF) [1][2][3]. The most extreme type of thermal injury is an atrioesophageal fistula (AEF), with a mortality rate of 80% or more [4][5][6][7][8]. Various strategies for protecting the esophagus during RF ablation or reducing the severity of injury have been developed, including power reduction, avoidance of greater contact force, temperature monitoring, esophageal deviation, and esophageal cooling, with varying degrees of success [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis

Leung

Gallagher

Tschabrunn

et al. 2019

J Interv Card Electrophysiol

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Purpose Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. Methods We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. Results A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation.

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Atrioesophageal Fistula After Atrial Fibrillation Ablation: A single center series

Cited by 14 publications

References 37 publications

Treatment Complications of Atrial Fibrillation and Their Management

Treatment Complications of Atrial Fibrillation and Their Management

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis

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