Global Survey of Esophageal Injury in Atrial Fibrillation Ablation: Characteristics and Outcomes of Esophageal Perforation and Fistula

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• 作者：Chirag R. Barbhaiya ; MD^a ; ^{chirag.barbhaiya@nyumc.org" class="auth_mail" title="E-mail the corresponding author} ; Saurabh Kumar ; BSc [Med] ; MBBS ; PhD^b ; Yu Guo ; MA^c ; Judy Zhong ; PhD^c ; Roy M. John ; MD ; PhD^b ; Usha B. Tedrow ; MD ; MSc^b ; Bruce A. Koplan ; MD ; MPH^b ; Laurence M. Epstein ; MD^a ; William G. Stevenson ; MD^b ; Gregory F. Michaud ; MD^a
• 关键词：atrial-esophageal fistula ; atrial fibrillation ; catheter ablation ; esophageal perforation
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：2
• 期：2
• 页码：143-150
• 全文大小：613 K

文摘

This study sought to assess the incidence, operator demographics, clinical characteristics, procedural factors, and prognosis of esophageal perforation and fistula after atrial fibrillation ablation.

Background

Esophageal injury is a feared complication of atrial fibrillation ablation.

Methods

An Internet-based global survey soliciting anonymous information regarding esophageal perforation and fistula was emailed to 3,080 physicians. Detailed information regarding physician, patient, and procedural characteristics related to esophageal perforation with or without fistula was collected.

Results

The survey was completed by 405 of 3,080 physicians (13%). Responding physicians performed 191,215 atrial fibrillation ablations and esophageal perforation with or without fistula occurred in 31 patients (0.016%) with multiple ablation catheter types despite monitoring of esophageal position or temperature during ablation in 90% of patients. Among patients who present with esophageal perforation, death, or severe neurologic injury occurred more frequently in patients with greater body mass index (30.9 ± 6.8 kg/m² vs. 25.8 ± 3.3 kg/m²; p = 0.03), and lower left ventricular ejection fraction (55.1 ± 9.1% vs. 61.7 ± 5.4%; p = 0.04). Among analyzed patients, atrial-esophageal fistula was seen in 72%, pericardial-esophageal fistula in 14%, and esophageal perforation without fistula in 14%. Mortality was 79% with atrial-esophageal fistula and 13% in esophageal perforation without atrial-esophageal fistula.

Conclusions

Esophageal perforation is rare but continues to occur with multiple catheter types despite esophageal monitoring during ablation. The prognosis of esophageal perforation is substantially improved if diagnosed and treated before development of atrial-esophageal fistula. An early surgical approach to esophageal perforation should be strongly considered regardless of evidence of fistula.