Examining the Risks and Benefits of Transesophageal Echocardiogram Imaging During Catheter Ablation for Atrial Fibrillation

Bunch, T. Jared; Day, John D.

doi:10.1161/circep.112.973297

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…When the probe is left during the procedure, it mechanically displaces the esophagus towards the ablation catheter, increasing the heat transfer to the esophageal mucosa. 58 Attempts to reduce temperature have been achieved with the use of cryoballoon technology for pulmonary vein isolation; however, despite this, AEF may still occur. 29 …”

Section: Discussionmentioning

confidence: 99%

Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

et al. 2015

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BackgroundAtrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation.ObjectiveTo identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality.MethodsA systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol.Results53 cases were identified. Mean age was 54±13 years; 73% (39/53) of cases occurred in males. Mean interval between procedure and presentation was 20±12 days, ranging from 2 to 60 days. AEF was observed in 12 patients who underwent surgical radiofrequency ablation (RFA) and in 41 patients with percutaneous RFA. Fever was the most common presenting symptom (n=44) followed by neurological deficits (n=27) and haematemesis (n=19). CT of the chest (n=27) was the preferred diagnostic test. Patients who did not receive a primary esophageal repair were more likely to have a deadly outcome (34% vs 83%; p<0.05). No difference in mortality rate was found between patients who underwent surgical RFA when compared with percutaneous RFA (58% vs 56%; p=0.579). No association was found between onset of symptoms and mortality (19±10 vs 23±14 days; p=0.355).ConclusionsAEF following ablation procedures for AF is a serious complication with high mortality rates. Presenting symptoms most often include a triad of fever, neurological deficit and/or haematemesis within 60 days of procedure. The preferred diagnostic test is CT of the chest. The treatments of choice is surgical repair.

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Section: Discussionmentioning

confidence: 99%

Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

et al. 2015

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“…24–6 The most recent results of a worldwide survey of ablation centres demonstrated no significant association between the use of EAM and subsequent freedom from AF. However, no other clinical outcomes were analysed, and data regarding other preprocedural and intraprocedural imaging modalities (TEE, CT, MRI, ICE) were not presented.…”

Section: Discussionmentioning

confidence: 99%

“…2 Furthermore, there is little evidence to demonstrate improved outcomes with any specific periprocedural imaging strategy. 4–6 Therefore, the objectives of the current analyses were to: (1) describe the contemporary use of periprocedural imaging technologies in a broad cohort of patients undergoing ablation for AF and (2) describe the association between periprocedural imaging use and outcomes. More specifically, we hypothesised that the use of periprocedural imaging would be associated with better outcomes postprocedure, including repeat ablation.…”

Section: Introductionmentioning

confidence: 99%

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

Steinberg

Hammill

Daubert

et al. 2014

Heart

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Objective Catheter ablation of atrial fibrillation (AF) has become an increasingly safe and effective therapy. This has been partly attributed to the use of adjunctive imaging modalities. We aimed to describe the use and associated outcomes of periprocedural imaging for AF ablation. Methods We studied all Medicare fee-for-service claims for AF ablation from July 2007 to December 2009, and identified associated imaging studies before and during ablation, including transoesophageal echocardiography (TEE), intracardiac echocardiography (ICE), CT and MRI. The primary outcomes were death, stroke or transient ischaemic attack (TIA), repeat ablation, and bleeding (pericardial or vascular) at 6 months. Results 11 525 patients underwent AF ablation during the study period. There was significant variation in imaging use at the practice level. In addition to electroanatomic mapping, 53% (n=6060/11 525) underwent TEE, 67% (n=7715/11 525) received ICE, and 50% (n=5724/11 525) underwent a preprocedure CT or MRI. Imaging generally increased from 2007 to 2009. After adjustment, the use of preablation CT or MRI was associated with a significantly lower risk of stroke or TIA (0.4% vs 0.9%, adjusted HR 0.46, 95% CI 0.28 to 0.74, p=0.002), and the use of ICE was associated with a lower risk of repeat ablation (5.7% vs 8.5%, adjusted HR 0.59, 95% CI 0.37 to 0.92, p=0.02) but higher risk of bleeding (1.1% vs 0.7%, adjusted HR 1.76, 95% CI 1.15 to 2.70, p=0.009). Conclusions Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.

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“…In 2001, Kallmeyer and colleagues [4] showed in a retrospective study of 7,200 adult cardiac surgical patients that a frequent TEE associated morbidity was odynophagia, which occurred in 0.1%; they reported no mortality. However, TEE has also been reported to cause other more rare but severe gastrointestinal complications, including esophageal perforation [5][6][7][8]. Although there have been more recent studies, most have largely been limited to small cohorts, with larger studies either having found very small numbers of complications or had limitations that precluded meaningful conclusions [9].…”

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confidence: 99%

Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study

Purza

Ghosh

Walker

et al. 2017

The Annals of Thoracic Surgery

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Examining the Risks and Benefits of Transesophageal Echocardiogram Imaging During Catheter Ablation for Atrial Fibrillation

Cited by 8 publications

References 23 publications

Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

Transesophageal Echocardiography Complications in Adult Cardiac Surgery: A Retrospective Cohort Study

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