Ferraz Alberto Pereira, Pisani Cristiano Faria, Rivarola Esteban Wisnivesky Rocca, Wu Tan Chen, Darrieux Francisco Carlos da Costa, Scanavacca Rafael Alvarenga, Hardy Carina Abigail, Chokr Muhieddine Omar, Hachul Denise Tessariol, Scanavacca Maurício Ibrahim
University of São Paulo Medical School, Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil.
J Interv Card Electrophysiol. 2024 Oct 22. doi: 10.1007/s10840-024-01922-8.
Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.
This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.
A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.
The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.
心房颤动（AF）消融术后的心房 - 食管瘘仍然是一个主要问题。目前尚无标准化方法来将这种严重并发症的风险和发病率降至最低。本研究的目的是介绍对AF导管消融术后食管损伤进行系统内镜监测的7年经验。
这是一项对2016年至2022年连续进行AF消融术后系统内镜评估的回顾性单中心登记研究。
在此期间，共分析了677例接受食管胃十二指肠镜检查（EGD）的AF消融手术。大多数患者为男性（71%），患有阵发性AF（71%）。633例患者（93.5%）的主要消融方法是使用电解剖标测的射频消融。220例患者（34.3%）使用单个传感器进行食管温度监测，296例患者（46%）使用多传感器探头。大多数患者未出现食管病变（75.7%）。其中46例（6.8%）发现严重病变（堪萨斯城分类KCC 2B），需要在7天内再次进行EGD检查。3例患者的KCC2B病变持续存在，其中2例在愈合过程中出现溃疡，1例有10毫米深溃疡的患者入院并接受禁食和肠外营养。溃疡在术后第二周愈合。两种食管温度监测策略在预防热损伤方面效果相当。此外，左心房（LA）较大与食管溃疡发生率较低相关（P = 0.028）。大多数病变可自发愈合。
消融术后食管损伤的发生率为24.3%。大多数（72%）为轻度病变，无需治疗干预。较大的左心房（LA）与热损伤发生率较低相关。早期内镜检查有助于诊断严重食管病变，并可为AF消融术后食管损伤的监测提供额外信息。
