Esophageal Thermal Injury Following Cryoballoon Ablation for Atrial Fibrillation.
atrial fibrillation
cryoballoon ablation
esophageal thermal injury
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
15
05
2019
revised:
08
10
2019
accepted:
21
10
2019
entrez:
21
3
2020
pubmed:
21
3
2020
medline:
14
4
2021
Statut:
ppublish
Résumé
This study evaluated the rate and predictors of endoscopically detected esophageal thermal lesions (EDEL) in patients who underwent cryoballoon atrial fibrillation (AF) ablation (CBA). EDEL is a known complication of catheter ablation for AF and is the inciting factor for atrial esophageal fistula formation. An observational study was conducted of patients with AF presenting for CBA. Pre-procedural magnetic resonance imaging was used to retrospectively evaluate the distance between the atrial endocardium and the esophageal lumen (AED). Intraprocedural esophageal luminal temperature and balloon temperatures were recorded. All patients underwent upper endoscopy (EGD) 24 h post-ablation. Clinical, anatomical, and ablation parameters were analyzed using logistic regression for association with thermal injury. A total of 95 patients (37% women; 71% paroxysmal AF) were included in the study. Esophageal thermal injury was detected on EGD in 21 patients (22%). EDEL was mostly mild (20 of 21 patients) and severe in only 1 of 21 patients. Univariate logistic regression identified gastroesophageal reflux disease to be associated with increased risk of thermal injury (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.00 to 10.46; p = 0.04), whereas a wider AED was protective (OR: 0.16; 95% CI: 0.05 to 0.515; p = 0.002). Esophageal wall thickness was also protective (OR: 0.04; 95% CI: 0.002 to 0.864; p = 0.04). In multivariate analysis, only AED (OR: 0.22; 95% CI: 0.06 to 0.77; p = 0.018) and obesity (OR: 4.63; 95% CI: 1.13 to 18.97; p = 0.033) were associated with EDEL. Esophageal luminal temperature, number, and duration of cryoballoon applications and balloon temperature were not predictors of EDEL. EDEL following CBA occurred in 22% of patients and was mostly mild. Obesity and atrioesophageal distance were independently associated with increased risk.
Sections du résumé
OBJECTIVES
This study evaluated the rate and predictors of endoscopically detected esophageal thermal lesions (EDEL) in patients who underwent cryoballoon atrial fibrillation (AF) ablation (CBA).
BACKGROUND
EDEL is a known complication of catheter ablation for AF and is the inciting factor for atrial esophageal fistula formation.
METHODS
An observational study was conducted of patients with AF presenting for CBA. Pre-procedural magnetic resonance imaging was used to retrospectively evaluate the distance between the atrial endocardium and the esophageal lumen (AED). Intraprocedural esophageal luminal temperature and balloon temperatures were recorded. All patients underwent upper endoscopy (EGD) 24 h post-ablation. Clinical, anatomical, and ablation parameters were analyzed using logistic regression for association with thermal injury.
RESULTS
A total of 95 patients (37% women; 71% paroxysmal AF) were included in the study. Esophageal thermal injury was detected on EGD in 21 patients (22%). EDEL was mostly mild (20 of 21 patients) and severe in only 1 of 21 patients. Univariate logistic regression identified gastroesophageal reflux disease to be associated with increased risk of thermal injury (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.00 to 10.46; p = 0.04), whereas a wider AED was protective (OR: 0.16; 95% CI: 0.05 to 0.515; p = 0.002). Esophageal wall thickness was also protective (OR: 0.04; 95% CI: 0.002 to 0.864; p = 0.04). In multivariate analysis, only AED (OR: 0.22; 95% CI: 0.06 to 0.77; p = 0.018) and obesity (OR: 4.63; 95% CI: 1.13 to 18.97; p = 0.033) were associated with EDEL. Esophageal luminal temperature, number, and duration of cryoballoon applications and balloon temperature were not predictors of EDEL.
CONCLUSIONS
EDEL following CBA occurred in 22% of patients and was mostly mild. Obesity and atrioesophageal distance were independently associated with increased risk.
Identifiants
pubmed: 32192675
pii: S2405-500X(19)30832-1
doi: 10.1016/j.jacep.2019.10.014
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
262-268Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.