Preventing atrioesophageal fistula

Abstract

We enjoyed reading "Atrioesophageal fi stula: A rare complication of catheter ablation for atrial fi brillation," by Sarah Jones, PA-C, and Areeba Kara, MD, MS, in the June issue. We would like to commend the authors for this informative report, and add further background and data on the topic, particularly with regard to the area of prevention, because as the authors point out, atrioesophageal fi stula has a mortality up to 80%, and cases often present with chest pain and undifferentiated sepsis, making diagnosis diffi cult.Focusing on the prevention of esophageal injuries such as atrioesophageal fi stula is ideal. Growing data have supported the use of active esophageal cooling, as opposed to luminal esophageal temperature (LET) monitoring. For example, recent randomized studies have shown greater esophageal injury with LET monitoring than without. 1 On the other hand, the impact study showed a reduction of 83% in esophageal injury with active esophageal cooling compared with LET monitoring. 2 Rapid adoption of this practice has resulted in the accumulation of data showing a range of ancillary benefi ts as well. For example, use of active esophageal cooling has been shown to have a signifi cant reduction in fl uoroscopy requirements. 3 In addition, our group and others recently presented data showing reduced procedure times as well as improvement in long-term freedom from dysrhythmia with cooling, presumably due to the improved ability to perform point-topoint ablation without interruption from local overheating. 4 JAAPA