Prevention of esophageal thermal injury during radiofrequency ablation for atrial fibrillation

Liu, Enzhao; Shehata, Michael; Liu, Tong; Amorn, Allen; Cingolani, Eugenio; Kannarkat, Vinod; Chugh, Sumeet S.; Wang, Xunzhang

doi:10.1007/s10840-011-9655-0

Cited by 33 publications

(17 citation statements)

References 52 publications

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“…19,20 The VN and its branches innervate most of the UGI system. The right and left VN descend alongside the esophagus into the abdomen, and their course in the posterior mediastinum is variable.…”

Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated. Methods and Results-We performed a prospective, observational study assessing the effect of atrial fibrillation ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study, and sham-feeding test (corresponding to esophageal, gastric, and small intestinal function evaluation, respectively) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 new abnormality on the UGI function tests (P<0.001). New onset esophageal dysmotility, delayed gastric emptying time, and abnormal sham-feeding tests were observed in 13 (48%), 13 (48%), and 9 (33%) patients, respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (P=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions-Atrial fibrillation ablation results in functional impairment of the UGI system, including the esophagus, stomach, and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.

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Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…[ 2–4 ] As the number of RFCA of AF cases grows, more AEF cases could be found in recent years. It was considered that the ablation of the posterior wall of LA by the high temperature might be an important risk of AEF [5] . Elevated esophageal temperatures during LA ablation may occur in more than 50% of patients.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for treating atrial-esophageal fistula

Zhou

Cen²,

Qian³

et al. 2016

Medicine

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Introduction:Atrial-esophageal fistula (AEF) is a rare severe disease, which may be associated with radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) or intraoperative radiofrequency ablation of atrial fibrillation (IRAAF).Clinical Findings:We reported a case of a 67-year-old man with AEF following RFCA of AF, who treated with esophageal stenting and surgical repair.Outcomes:He was attacked by out-of-control sepsis and infectious shock after surgery and died.Literature review:We analyzed 57 relevant articles about AEF from 2003 to 2015 by searching PubMed database. According literatures, the most common symptoms were fever, rigor, sepsis, and neurologic symptoms. Chest computer tomography (CT) and contrast enhanced CT may be the reliable noninvasive diagnosis methods because of high sensitive for AEF.Conclusion:Make a definition diagnosis in time with early primary surgical repair may save their lives. Conservative treatment or esophageal stenting alone may not be a better choice for AEF patients.

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“…The diagnosis of AOF can be performed with CT/MRI of the chest. A variety of different methods are employed during RFA to reduce the risk of thermal injury to the oesophagus, including high-dose proton-pump inhibitor therapy and use of oesophageal temperature probes to monitor temperature during the RFA 2 4 5…”

Section: Discussionmentioning

confidence: 99%

Unusual cause of upper gastrointestinal bleed, when OGD could be fatal

et al. 2015

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SUMMARYA 57-year-old man presented with chest pain, dyspnoea and coffee grounds emesis. He was haemodynamically stable without significant drop in haemoglobin. He suddenly developed cardiac arrest with wide complex tachycardia and became comatose. CT scan of the head revealed pneumocephalus and multiple infarcts. Given the recent history of radiofrequency ablation for atrial fibrillation, atrio-oesophageal fistula (AOF) was suspected. CT angiography of the thorax showed a 5 mm diverticulum on the posterior wall of the left atrium, also raising suspicion for AOF. The patient was taken to the operating room. An AOF was found and repaired. He did not have any further gastrointestinal bleeding. There was no neurological recovery at day 11 and life support was withdrawn per his family's request. This case highlights the importance of obtaining history of recent cardiac procedures in patients presenting with an upper gastrointestinal bleed. An oesophagogastroduodenoscopy in this patient could have been instantaneously deadly. BACKGROUND

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Prevention of esophageal thermal injury during radiofrequency ablation for atrial fibrillation

Cited by 33 publications

References 52 publications

Effect of Atrial Fibrillation Ablation on Gastric Motility

Effect of Atrial Fibrillation Ablation on Gastric Motility

Treatment strategy for treating atrial-esophageal fistula

Unusual cause of upper gastrointestinal bleed, when OGD could be fatal

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