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document
Esophageal damage during radiofrequency ablation of atrial fibrillation : impact of energy settings , lesion sets , and esophageal visualization . INTRODUCTION Atrioesophageal fistula is an uncommon but often lethal complication of atrial fibrillation ( AF ) ablation . The purpose of our study was to prospectively investigate the incidence of esophageal ulcerations ( ESUL ) as well as the impact of energy settings , radiofrequency lesion sets , and direct visualization of the esophagus on esophageal wall injury . METHODS AND RESULTS One hundred seventy-five patients , 57.1 % paroxysmal AF , 78.5 % male , underwent AF ablation and esophagoscopy 24 hours thereafter . We performed a 2:1:1-randomization as follows : CONTROL GROUP Ablation without visualization of the esophagus using 25 Watt ( W ) power limit on the posterior wall , n = 70 . Visualization and 15 W maximum : Ablation guided by barium visualization of the esophageal course using a limit of 15 W , n = 35 . Visualization and 25 W " short burns " : Ablation guided by barium visualization using 25 W and " short burns " ( max . 5 sec ) , n = 35 . Patients performed under general anesthesia ( n = 35 ) were separated as a nasogastric tube for visualization of the esophagus was used . In total , we found 2.9 % of patients ( 5/175 ) presenting ESUL . Parameters discriminating the development of ESUL in a specific patient were type of AF , maximum energy delivered , usage of a nasogastric tube , and additional left atrial lines . Visualization of the esophageal course by barium contrast was not able to prevent ESUL . CONCLUSION ESUL is a rare finding when using a reasonable energy maximum of 25 W with open-irrigated tip catheters at the posterior wall . Lower energy settings may increase safety without losing efficacy . Additional linear radiofrequency lesions increase the risk of ESUL development .
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Intervention_Physical
radiofrequency ablation
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Intervention_Physical
AF ablation
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Intervention_Physical
esophagoscopy
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Intervention_Physical
Ablation without visualization of the esophagus
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Intervention_Physical
Ablation guided by barium visualization
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Intervention_Physical
Ablation guided by barium visualization using 25 W and " short burns "
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Outcome_Physical
esophageal ulcerations ( ESUL )
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Outcome_Physical
ESUL
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Outcome_Physical
ESUL
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Outcome_Physical
AF , maximum energy delivered , usage of a nasogastric tube , and additional left atrial lines .
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Outcome_Physical
ESUL
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Participant_Condition
atrial fibrillation ( AF ) ablation
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Participant_Sample-size
One hundred seventy-five patients
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Participant_Sex
male
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Participant_Condition
AF ablation and esophagoscopy