• Philipp Halbfass, Borche Pavlov, Patrick Müller, Karin Nentwich, Kai Sonne, Sebastian Barth, Karsten Hamm, Franziska Fochler, Andreas Mügge, Ulrich Lüsebrink, Rainer Kuhn, and Thomas Deneke.
• From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology Bad Neustadt an der Saale, Germany (R.K.). philipp.halbfass@kardiologie-bad-neustadt.de.
• Circ Arrhythm Electrophysiol. 2017 Aug 1; 10 (8).

BackgroundUp to 40% of patients demonstrate endoscopically detected asymptomatic esophageal lesions (EDEL) after atrial fibrillation ablation.Methods And ResultsPatients 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 lesions (absolute risk, 9.6%). In a logistic regression analysis, ulcers were identified to be a significant predictor for esophageal perforating complications.ConclusionsPostablation endoscopy seems to identify patients at high risk of esophageal perforating complications only occurring in patients with category 2 EDEL. One out of 10 postablation esophageal ulcers progressed to perforation, and no patient without esophageal thermal ulcers showed the occurrence of perforating esophageal complications.© 2017 American Heart Association, Inc.

26 keywords...

hide…