Esophageal Contour Changes during Cryoablation of Atrial Fibrillation

Herweg, Bengt; Ali, Rias; Khan, Nadim G.; Ilercil, Arzu; Barold, S. Serge

doi:10.1111/j.1540-8159.2009.02356.x

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…Although left atrial-esophageal fistulae are rare (occurring after <0.1-0.25% of AF ablation procedures) [386,420,506,549], injury to the esophagus is common following AF ablation. In several clinical studies, endoscopy performed 1-3 days after AF ablation using RF energy, HIFU, laser balloon, or cryothermia identified an asymptomatic esophageal ulcer (directly behind the LA) in 4-60% (generally 15-20%) of patients [282,428,432,[580][581][582][583][584][585][586][587][588]. The asymptomatic esophageal ulcers were usually healed on repeat endoscopy at 2-3 weeks following treatment with a proton pump inhibitor and a cytoprotective agent such as sucralfate [583,586].…”

Section: Esophageal Injurymentioning

confidence: 99%

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

Calkins

Kuck

Cappato

et al. 2012

J Interv Card Electrophysiol

1,466

680

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This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.

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Section: Esophageal Injurymentioning

confidence: 99%

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

Calkins

Kuck

Cappato

et al. 2012

J Interv Card Electrophysiol

1,466

680

View full text Add to dashboard Cite

show abstract

“…Catheter ablation has been reported to cause injury to the surrounding plexuses by causing changes in esophageal temperature. [ 20 , 21 ] It has also been associated with increased incidences of esophageal spasm, gastrointestinal dysmotility, and gastroesophageal reflux, which may result in a reversible delay in gastrointestinal clearance and the lodging of medications in the gastrointestinal tract. [ 22 ] Second, this is the retrospective study at a single center and the sample number is not large.…”

Section: Discussionmentioning

confidence: 99%

The Risks of Exfoliative Esophagitis in Patients with Atrial Fibrillation

Tajima¹,

Narasaka²,

Akutsu³

et al. 2020

Medicine

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The aging of the population has resulted in atrial fibrillation (AF) becoming increasingly prevalent. Treatment focuses on the prevention of thromboembolism through the use of catheter ablation or drug therapy with anticoagulants, such as warfarin or direct oral anticoagulants (DOACs). Dabigatran-induced exfoliative esophagitis has been reported as a rare side effect of DOACs. Although most cases are mild, some result in severe outcomes. However, the etiology of exfoliative esophagitis remains incompletely understood. The aim of this study is to investigate the etiology of exfoliative esophagitis and identify its risk factors by observational study. The participants were 524 patients using anticoagulants who received catheter ablation for AF and subsequently underwent upper gastrointestinal endoscopy at University of Tsukuba Hospital. Exfoliative esophagitis was noted in 21 (4.0%) patients. Potential risk factors for exfoliative esophagitis were examined retrospectively by comparing patients with and without this condition across the following parameters that were extracted retrospectively from the electronic medical records: physical characteristics, comorbidities, blood-based cardiac markers, echocardiographic and endoscopic findings, and current medications. Regarding physical characteristics, patients with exfoliative esophagitis had significantly higher body weight and BMI. No association was observed between exfoliative esophagitis and comorbidities. Associations were also not found for cardiac markers, echocardiographic findings, or endoscopic findings. In terms of current medications, patients receiving oral dabigatran showed the highest prevalence of exfoliative esophagitis at 8.8% (13/148). The adjusted odds ratio of dabigatran for exfoliative esophagitis was 10.3 by multivariable logistic regression analysis. Obesity and oral dabigatran were found to be significant risk factors for exfoliative esophagitis.

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“…Although the risk of esophageal complications associated with cryoablation was higher, the patients in that study were asymptomatic and they did not have any sequelae. Esophageal contour changes during cryoablation of atrial fibrillation using barium enema may result from ice ball formation causing passive tissue displacement or esophageal spasm (7).…”

Section: Discussionmentioning

confidence: 99%

Profuse and acute hemorrhagic gastroesophageal injury after cryotherapy in a cardiac surgery patient

Kim

Lee

et al. 2017

J. Thorac. Dis.

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Upper gastrointestinal injury associated with cryoablation and under placement of transesophageal echocardiography (TEE) during cardiac surgery is a rare complication but potentially fatal.During the cryoablation for the treatment of atrial fibrillation, delivered cryoenergy can adversely affect the esophagus, resulting in gastroesophageal ulceration. The TEE probe itself also can induce adverse effects like esophageal ulceration or perforation. In this case report, we describe a case of emergent gastroesophageal injury with massive bleeding that occurred after manipulation of a TEE probe during cryoablation therapy in a cardiac surgery patient.

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Esophageal Contour Changes during Cryoablation of Atrial Fibrillation

Abstract: Esophageal contour changes were observed in >6% of cryo applications in direct proximity to the esophagus (32% of patients) and were most frequent in the posterior aspect of the left common and right lower PV ostium when cryo-energy was delivered at a distance of

Cited by 10 publications

References 13 publications

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

The Risks of Exfoliative Esophagitis in Patients with Atrial Fibrillation

Profuse and acute hemorrhagic gastroesophageal injury after cryotherapy in a cardiac surgery patient

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