Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high?

Abstract

Left atrial IRAAF is associated with a small but definite risk of esophageal perforation. Unfortunately, we were unable to identify any risk factors for this life-threatening complication. A high degree of vigilance must be maintained for esophageal injury after IRAAF, particularly in patients with new neurologic deficits. Until safer methods of ablation are developed, we currently recommend against the use of IRAAF in patients undergoing cardiac surgery.

Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial Fibrillation

“…4 Our cases demonstrate that this complication may also result from percutaneous radiofrequency catheter ablation in the LA.…”

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

“…806,866,920,1162,1163,1164,1165,1166,1167,1168,1169 It is a possible complication after catheter ablation using any energy modality that produces transmural atrial lesions. Although early reports showed AEF resulting from RF ablation, more recently, AEFs have also been reported after CBA.…”

Catheter Ablation of Atrial Fibrillation

“…29,50,51 The most feared complication of AF ablation is the creation of an atrioesophageal fistula, which has a declining incidence of 0.01-0.03% of patients. 52,53 Both real-time temperature recordings in the esophagus during ablation and contrast imaging have become standard. Specialized techniques such as placement of an intrapericardial balloon to create separation between the atrium and esophagus can be implemented if a targeted region directly overlies the esophagus.…”