Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
+44 1300 500008
ISSN: 2155-9880
+44 1300 500008
Thomas Deneke
Heart Center Bad Neustadt, Germany
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Atrioesophageal fistula (AEF) is a rare but devastating complication of atrial fibrillation (AF) ablation (incidence 0.01 to 0.2%). Asymptomatic thermal esophageal lesions (EDEL) related to AF ablation occur in up to 60% of patients and are considered a precursor for AEF. Due to the rarity of AEF systematic analysis of related factors is impossible and EDEL have been used as a surrogate endpoint evaluating the risk factors for esophageal damage. In our experience EDEL occur in 8.1% of AF ablation cases when using cautious ablation at the posterior wall with a maximum of 25W irrigated radiofrequency (RF) ablation. Current studies indicate a higher incidence of EDEL when using non-insulated thermal esophageal temperature monitoring during RF ablation (32.5% vs. 6.9%, p<0.01) compared to not using any temperature monitoring at all. Using insulated thermal esophageal temperature probes produces comparable incidences of EDEL (7.5%) during RF ablations. Using optimized high-irrigation tip catheters or cryoballoon 2nd generation is related to an incidence of EDEL of 12 to 18%. Out of a total of 2897 patients including 237 with EDEL 0.03% of erythemas and 0.09% of esophageal ulcers proceed to perforation. Systematic algorithm shows to deal with patients with EDEL are being evaluated within the German working group on arrhythmias.