Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, Hangzhou, Zhejiang, China.
Pacing Clin Electrophysiol. 2020 Jul;43(7):646-654. doi: 10.1111/pace.13939. Epub 2020 May 27.
Catheter ablation has emerged as an effective treatment for atrial fibrillation (AF). Atrial esophageal fistula (AEF) is a rare, but feared complication. With increasing utilization of ablation therapy for AF, the understanding of the relationship between AEF and ablation has been improved in recent years. Efforts to reduce the risk of AEF have focused on decreasing the risk of severe esophageal injury (EI) and the presumed subsequent progression from EI to AEF, including esophageal temperature monitoring, esophageal cooling systems, esophageal deviation devices, and decreasing and/or curtailing ablation energy delivery. Periprocedural assessment may help identify higher risk patients and detect early esophageal lesions. This review systematically summarizes and evaluates the current strategies and techniques utilized to reduce the risk of AEF in the clinical workflow for AF ablation. We expect that this review will help clinicians to better understand the principles, advantages, and disadvantages of these methods, and to find suitable strategies using current available tools.
导管消融已成为治疗心房颤动 (AF) 的有效方法。食管心房瘘 (AEF) 是一种罕见但令人恐惧的并发症。随着导管消融治疗 AF 的应用日益增多，近年来对 AEF 与消融之间关系的认识有所提高。减少 AEF 风险的努力集中在降低严重食管损伤 (EI) 的风险和随后推测的从 EI 到 AEF 的进展，包括食管温度监测、食管冷却系统、食管偏移装置以及减少和/或缩短消融能量输送。围手术期评估可能有助于识别高风险患者并早期发现食管病变。本综述系统总结和评估了目前在 AF 消融的临床工作流程中用于降低 AEF 风险的策略和技术。我们期望本综述将帮助临床医生更好地理解这些方法的原理、优点和缺点，并利用现有工具找到合适的策略。
