Author + information
- Received July 24, 2018
- Revision received August 14, 2018
- Accepted August 16, 2018
- Published online December 17, 2018.
- Takashi Kaneshiro, MDa,b,∗ (, )
- Yoshiyuki Matsumoto, MDa,
- Naoko Hijioka, MDa,
- Minoru Nodera, MDa,
- Shinya Yamada, MDa,
- Masashi Kamioka, MDa,
- Akiomi Yoshihisa, MDc,
- Hiroshi Ohkawara, MDd,
- Hitoshi Suzuki, MDa and
- Yasuchika Takeishi, MDa,b
- aDepartment of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- bDepartment of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
- cDepartment of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
- dDepartment of Hematology, Fukushima Medical University, Fukushima, Japan
- ↵∗Address for correspondence:
Dr. Takashi Kaneshiro, Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
Both conventional radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA) have been widely accepted as a treatment for atrial fibrillation. Esophageal erosion/ulcer is important in catheter ablation of atrial fibrillation because it has a potential to advance to left atrial-esophagus fistula, which is a fatal complication associated with pulmonary vein (PV) isolation (1,2). However, the differences in detailed mechanisms of this complication has been obscure.
We have routinely examined esophagogastroduodenoscopy to check the esophageal lesion after PV isolation and found that about 2% to 5% of patients who underwent PV isolation by RFCA or CBA had esophageal lesions after PV isolation (3). All esophageal lesions in patients with RFCA showed spot lesions in the anterior wall of esophagus (Figure 1A), which touches the left atrial posterior wall. This finding suggests that the mechanism of esophageal lesions in RFCA is the direct thermal injury by an ablation catheter. However, in our experiences, most of the esophageal lesions showed linear, longitudinal forms in patients with CBA (Figure 1B). It is noteworthy that the esophageal lesions existed circumferentially around the esophageal lumens. The cause of esophageal lesions remains unclear, but some possible mechanisms are speculated: 1) mechanical pressure from the cryoballoon might compress the esophagus and make the lesions contiguous from front to back; and 2) additional impairment of periesophageal circulation by the strong cooling effect of a second-generation cryoballoon might contribute to the wide-ranging esophageal lesions (4). These differences in typical forms of esophageal lesions suggest that the mechanisms of esophageal lesions are different between RFCA and CBA, and thus elucidation of the mechanisms and distinct protective approaches should be required.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All 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 July 24, 2018.
- Revision received August 14, 2018.
- Accepted August 16, 2018.
- 2018 American College of Cardiology Foundation
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