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Anatomical, procedural information linked to esophageal ulceration in patients undergoing radiofrequency catheter ablation

Martinek M. Heart Rhythm. 2010;doi:10.1016/j.hrthm.2010.02.027.

Issue: October 2010

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For the first time, a link between anatomical and procedural information and esophageal ulceration in patients with atrial fibrillation undergoing radiofrequency catheter ablation has been found, according to a new study appearing in Heart Rhythm.

The study featured 267 patients who were consecutively screened for esophageal ulceration (ESUL) 24 hours after radiofrequency catheter ablation of AF via endoscopy of the esophagus. Researchers performed a standardized ablation approach utilizing a 25 W energy maximum at the posterior left atrial wall without esophagus visualization, temperature monitoring or intracardiac ultrasound.

Among patients, 2.2% (n=6) presented with ESUL. Parameters exposing a specific patient to risk of developing ESUL in univariate analysis included: persistent AF (5 of 95, P=.023), additional lines performed (roofline: 6 of 114, P=.006; left atrial isthmus: 4 of 49, P=.011; coronary sinus: 5 of 66, P=.004) and left atrial enlargement (P=.001), leading to what researchers termed as a “sandwiching of the esophagus between the left atrium and thoracic spine.”

Furthermore, according to researchers, multivariate analysis revealed the anatomical risk factor of a small left atrium-to-esophageal distance as the most important factor in ESUL development.

“This study is the first to link anatomical information and procedural considerations to the development of ESUL in radiofrequency ablation for AF,” the researchers wrote in their study. “Our data give new insights into risk factors for ESUL development, especially on the linkage of these parameters and the correlation to each other. Identifying high-risk patients for esophageal injury potentially has an impact on follow-up or treatment of these individuals by endoscopy or prophylactic proton pump inhibitor treatment.”

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