Author + information
- Received May 15, 2019
- Revision received October 8, 2019
- Accepted October 21, 2019
- Published online March 16, 2020.
- Sakher Y. Sarairah, MD,
- Brandon Woodbury, MD,
- Nilubon Methachittiphan, MD,
- Deanna M. Tregoning, MSN,
- Arun R. Sridhar, MBBS and
- Nazem Akoum, MD, MS∗ (, )@nazemakoum
- ↵∗Address for correspondence:
Dr. Nazem Akoum, Department of Cardiology, University of Washington, 1959 Northeast Pacific Street, Box 356171, Seattle, Washington 98195-6171.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 15, 2019.
- Revision received October 8, 2019.
- Accepted October 21, 2019.
- 2020 American College of Cardiology Foundation
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