Oesophageal Injury During AF Ablation: Techniques for Prevention

Romero, Jorge; Avendaño, Ricardo; Grushko, Michael; Díaz, Juan Carlos; Du, Xianfeng; Gianni, Carola; Biase, Luigi Di

doi:10.15420/aer.2017.46.2

Cited by 16 publications

(11 citation statements)

References 66 publications

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“…[ 1 ] This is a direct result of the proximity of the oesophagus and the posterior wall of the LA. [ 28 , 29 ] In RF ablation, strategies such as modifying energy delivery at the posterior LA close to the oesophagus can minimise the risk. However, in the CB ablation, the posterior LA lesion size cannot specifically be controlled.…”

Section: Oesophageal Injury and Atrio-oesophageal Fistulaementioning

confidence: 99%

Complications of Cryoballoon Pulmonary Vein Isolation

Miyazaki

Tada

2019

Arrhythm Electrophysiol Rev

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Since the cryoballoon (CB) was introduced into clinical practice, more than 400,000 patients have undergone a pulmonary vein (PV) isolation with a CB throughout the world. Although the efficacy of the first-generation CB was limited, the recently introduced secondgeneration CB has achieved a greater uniformity in cooling, which has facilitated a shorter time to PV isolation, shorter procedural times, higher rates of freedom from atrial fibrillation and low rates of PV reconnections. Currently, a single short freeze strategy with a single 28 mm balloon has become the standard technique based on the balance of procedural efficacy and safety. However, enhanced cooling characteristics may also result in a greater potential for collateral damage to non-cardiac structures. Knowledge about the potential complications is essential when performing the procedure. In this article, we describe the important complications that should be noted during a CB procedure, and how to minimise the risk of complications based on our experience.

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Section: Oesophageal Injury and Atrio-oesophageal Fistulaementioning

confidence: 99%

Complications of Cryoballoon Pulmonary Vein Isolation

Miyazaki

Tada

2019

Arrhythm Electrophysiol Rev

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“…Current catheter-based strategies to address posterior wall substrate include high-power, short-duration application of radiofrequency energy to theoretically limit deep ablation; real-time temperature monitoring; oesophageal deviation; and cryoballoon across the posterior space. [ 40 ] Despite the endocardial energy used, oesophageal injury during posterior wall catheter ablation can occur, and although the occurrence of an atrioesophageal fistula is of low relative frequency, the high mortality of this complication necessitates standardised ablation protocols and close post-procedural surveillance.…”

Section: Posterior Wall Isolationmentioning

confidence: 99%

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Wats¹,

Kiser²,

Makati³

et al. 2020

Arrhythmia &Amp; Electrophysiology Review

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The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.

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“…For the surgeon facing this dreaded complication, it may be a ‘once in a lifetime’ case. With the incidence of AOF reported to range between 0.01% and 0.25%, 7–9 we estimate that a cardiothoracic surgeon working in the United Kingdom will come across a maximum of three cases in a 30‐year career 10,11 . A swift decision on the best way in which to proceed will be challenging.…”

Section: Introductionmentioning

confidence: 99%

Acquired atrioesophageal fistula: Need it be lethal? Sizing up the problem, diagnostic modalities, and best management

Povey

Page

Large

2022

Journal of Cardiac Surgery

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Background and Aim of the Study An atrioesophageal fistula is a devastating complication of ablation for atrial fibrillation. For the surgeon facing this dreaded complication, it may be a ‘once in a lifetime’ case. This review aims to describe the clinical problem and evaluate the outcome of different surgical techniques to start guiding cardiothoracic surgeons toward those which offer the best chance of survival. Methods An electronic search retrieved 125 articles containing 195 cases of atrioesophageal fistula secondary to atrial fibrillation ablation. Reports of pericardio‐esophageal or mediastino‐esophageal fistula were excluded. Results The median age was 61 and 143 (73%) cases occurred in males. Fever (n = 147; 75%) and neurological dysfunction (n = 151; 77%) were the most common symptoms. The median time from ablation to symptom onset was 21 days (interquartile range: 12–28). The most sensitive thoracic imaging modality was computed tomography (n = 135/153; 90%). Immediate deterioration occurred during 11/58 (19%) oesophago–gastro–duodenoscopies. Mortality was lower in patients who had surgery (39%) compared with endoscopic intervention (94%) or conservative management (97%). Patients who had atrial repair combined with esophageal repair or oesophagectomy were more likely to survive than those who had atrial repair alone (OR 6.97; p < .001). Isolation of the esophageal aspect of the fistula conferred an additional survival benefit (OR 5.85; p = .02). Conclusions Fever, neurological symptoms, and chest pain in the context of recent ablation should prompt immediate evaluation. Urgent CT thorax should be arranged and repeated if initially unremarkable. Esophageal instrumentation should be avoided due to the risk of catastrophic air embolism or massive hemorrhage. The best way forward is emergency surgical repair; the combination which offers the best survival benefit is atrial repair combined with esophageal surgery and isolation of the esophageal aspect of the fistula.

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Oesophageal Injury During AF Ablation: Techniques for Prevention

Cited by 16 publications

References 66 publications

Complications of Cryoballoon Pulmonary Vein Isolation

Complications of Cryoballoon Pulmonary Vein Isolation

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Acquired atrioesophageal fistula: Need it be lethal? Sizing up the problem, diagnostic modalities, and best management

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