Key result
Maximum esophageal temperature ≥38°C during AF ablation was not associated with increased AF recurrence (OR 1.65; 95% CI 0.84-3.24; p=0.14), and overall incidence of esophageal lesions was 3.8%.
Why the study?
Severe esophageal thermal injury and atrioesophageal fistula are feared complications of AF ablation, making it important to evaluate safe methods to prevent esophageal injuries without increasing AF recurrence.
Does a specific esophageal protection protocol during radiofrequency AF ablation prevent esophageal thermal injury without increasing AF recurrence in patients undergoing AF ablation?
Cohort (n=104)
Does a specific esophageal protection protocol during radiofrequency AF ablation prevent esophageal thermal injury without increasing AF recurrence in patients undergoing AF ablation?
Using a specific esophageal protection protocol during AF ablation results in a low incidence of esophageal thermal injury without increasing the risk of AF recurrence.
Does not support changing esophageal monitoring thresholds during AF ablation; hypothesis-generating and requires randomized confirmation.
Objective: Catheter ablation has been a common procedure used for the management of atrial fibrillation (AF). Atrioesophagel fistula (AEF) is one of the most feared complications of AF ablation. Although it is a rare complication, severe esophageal thermal injury must be avoided. It is important to describe a safe method of preventing esophageal injuries without increasing AF recurrence. Methods: A retrospective cohort study of consecutive patients who underwent radiofrequency AF catheter ablation during 1 year-period wa conducted. One hundred and four patients were enrolled divided in two groups: one with a maximum recorded esophageal temperature (ET) < 38 °C and other with a maximum recorded ET ≥ 38 °C. The primary endpoint was detection of endoscopic esophageal lesions after AF ablation and the secondary endpoint was AF recurrence according to the maximum ET reached during the procedure. Results: The maximum ET was on average 37.3 ± 1.0 °C. Only 4 (3.8%) patients had esophageal lesion diagnosed by upper gastrointestinal endoscopy. There were no cases of esophageal perforation. The AF recurrence rate was 9.6% during the follow-up (10 patients, 3 from the ET max < 38 °C group and 7 from the ET max ≥ 38 °C group; p = 0.181). The maximum ET was not associated with AF recurrence after catheter ablation (OR = 1.65, 95% CI = 0.84-3.24, p = 0.14). Conclusions: A low incidence of esophageal injury after AF ablation with the use of a specific esophageal protection protocol was found. There was no esophageal perforation. The AF recurrence rate was similar to that described in the literature.
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Borges et al. (2020) conducted a cohort in Atrial fibrillation (n=104). Maximum recorded esophageal temperature ≥ 38 °C vs. Maximum recorded esophageal temperature < 38 °C was evaluated on Detection of endoscopic esophageal lesions after AF ablation. Maximum esophageal temperature ≥38°C during AF ablation was not associated with increased AF recurrence (OR 1.65; 95% CI 0.84-3.24; p=0.14), and overall incidence of esophageal lesions was 3.8%.
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