The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience
- 7 December 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Interventional Cardiac Electrophysiology
- Vol. 39 (2), 139-144
- https://doi.org/10.1007/s10840-013-9853-z
Abstract
Atrioesophageal fistula (AEF) is an infrequent complication of radiofrequency (RF) ablation for atrial fibrillation (AF). The aim of this study was to determine the prevalence and operator-dependent factors associated with AEF using a nationwide survey of electrophysiologists (EP). Thirty-eight EPs performing AF ablation between 2008 and 2012 were invited to complete a web-based questionnaire assessing the prevalence and factors associated with AEF. Responses were obtained from 25 EPs (68 %) accounting for 7,016 AF ablations. Five cases of proven AEF (0.07 %) were reported. Operators who reported AEF [AEF (+)] more often used general anesthesia (GA) [90 % AEF (+) vs. 44 % AEF (−), p = 0.046]. AEF (+) operators were also more likely to be users of the non-brushing technique in the posterior wall of the LA [5 (100 %) AEF (+) vs. 5 (25 %) AEF (−), p = 0.005]. The combined usage of GA and non-brushing technique during LA posterior wall ablation had a strong association with AEF (+) operators [4 (80 %) AEF (+) vs. 2 (10 %) AEF (−), p = 0.002]. There was a trend towards higher maximal RF energy setting in the posterior wall [47.4 + 7.6 AEF (+) vs. 40.2 + 8 AEF (−), p = 0.09]. Other procedure parameters were similar. The reported prevalence of AEF among Canadian AF ablators is 0.07 %. AEF was associated with high mortality. The use of GA and non-brushing movements during posterior wall ablation were two factors associated with AEF.Keywords
This publication has 15 references indexed in Scilit:
- 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 DesignA report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm SocietyEP Europace, 2012
- Prevention of atrial–esophageal fistula after catheter ablation of atrial fibrillationCurrent Opinion in Cardiology, 2011
- Pneumopericardium Following Radiofrequency Ablation for Atrial Fibrillation: Insights into the Natural History of Atrial Esophageal Fistula FormationJournal of Cardiovascular Electrophysiology, 2010
- A Delayed Case of Fatal Atrioesophageal Fistula Following Radiofrequency Ablation for Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2010
- Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial FibrillationCirculation: Arrhythmia and Electrophysiology, 2010
- Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial FibrillationCirculation: Arrhythmia and Electrophysiology, 2009
- Assessment of Temperature, Proximity, and Course of the Esophagus During Radiofrequency Ablation Within the Left AtriumCirculation, 2005
- Computed Tomographic Analysis of the Anatomy of the Left Atrium and the EsophagusCirculation, 2004
- Analysis of Catheter-Tip (8-mm) and Actual Tissue Temperatures Achieved During Radiofrequency Ablation at the Orifice of the Pulmonary VeinCirculation, 2004
- Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high?The Journal of Thoracic and Cardiovascular Surgery, 2003