Key result
Lower BMI and reduced LVEF linked to higher esophageal injury risk after AF ablation.
Why the study?
Esophageal injury is a potentially serious complication of AF catheter ablation, but data on its incidence and risk factors after RFCA and CBA remain limited.
Lower BMI and reduced LVEF are independent risk factors for esophageal injury after catheter ablation for atrial fibrillation, supporting selective endoscopic screening in high-risk patients.
May inform risk stratification for post-AF ablation esophageal injury; leaves open whether selective screening improves outcomes.
Background and Aims Esophageal injury (EI) is a potentially serious complication of catheter ablation (CA) for atrial fibrillation (AF). However, data on its incidence and risk factors, particularly after radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA), remain limited. This study aimed to identify predictors of EI in patients undergoing RFCA and CBA. Methods In this retrospective study, patients with AF who underwent de novo RFCA or CBA between December 2019 and April 2022 were evaluated. All underwent EGD within 2 days post‐ablation. EI severity was graded, and clinical predictors were analyzed using multivariate logistic regression. Results Among 584 patients (mean age 62.8 ± 11.2 years, 68.6% male), 30 (5.1%) developed EI (RFCA: 5.0%, CBA: 6.3%). Most injuries were mild (Class I), and all resolved with proton pump inhibitor therapy. Compared with those without EI, affected patients had significantly lower body mass index (BMI) (24.5 ± 3.9 vs. 25.9 ± 3.4 kg/m 2 , p = 0.030) and reduced ejection fraction (EF) (48.9% ± 8.7% vs. 52.8% ± 6.8%, p = 0.023). Multivariate analysis identified BMI ≤ 24 kg/m 2 (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.69–7.96) and EF ≤ 40% (OR, 4.08; 95% CI, 1.54–11.56) as independent risk factors. Conclusions Esophageal injury after catheter ablation for atrial fibrillation is not rare, but usually mild. Lower BMI and reduced LVEF were independent risk factors, regardless of ablation type. These results support selective endoscopic screening in high‐risk patients to enable early detection and prevent severe complications.
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Choi et al. (2026) studied this question. Lower BMI (≤24 kg/m²) and reduced LVEF (≤40%) independently increased esophageal injury risk after AF catheter ablation, occurring in 5.1% of patients.
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