Borges Anibal Pires, Kalil Carlos, Brugada Josep, Yanez José Plutarco Gutiérrez, Soliz Pablo da Costa, Saffi Marco Aurelio Lumertz, Silveira Anderson Donelli da, Pimentel Maurício
Programa de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Santa Casa de Porto Alegre, Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2025 Nov;122(11):e20250290. doi: 10.36660/abc.20250290.
Atrial fibrillation (AF) ablation has been increasingly employed as an effective strategy for rhythm control, leading to a reduction in arrhythmia burden, improved quality of life, and, in selected cases, decreased mortality. However, as an invasive procedure, it carries inherent risks. Severe esophageal complications-such as esophageal perforation or atrioesophageal fistula- though rare (with an incidence ranging from 0.025% to 0.113%), are associated with significant morbidity and mortality. Multiple risk factors for esophageal injury have been identified, including both patient-related and procedure-related characteristics. To mitigate these risks during radiofrequency (RF) ablation, several preventive measures have been adopted, including the use of contact force catheters, high-power short-duration energy applications, and protective strategies such as esophageal temperature monitoring, displacement devices, and cooling techniques. Deep esophageal lesions detected through surveillance endoscopy are considered potential precursors to more serious complications and, therefore, warrant close attention. Enhanced monitoring of patients with such lesions may be crucial for enabling early diagnosis and timely intervention to prevent the progression to more severe complications. While pulsed field ablation therapy, which poses a lower risk to the esophagus and other surrounding structures, is not yet widely available, the implementation of robust monitoring strategies can significantly improve clinical outcomes and enhance patient safety in the context of RF AF ablation.
心房颤动（AF）消融术已越来越多地被用作一种有效的节律控制策略，可减轻心律失常负担、改善生活质量，在某些情况下还可降低死亡率。然而，作为一种侵入性手术，它存在固有风险。严重的食管并发症，如食管穿孔或心房食管瘘，虽然罕见（发生率在0.025%至0.113%之间），但却与显著的发病率和死亡率相关。已确定了多种食管损伤的风险因素，包括与患者相关和与手术相关的特征。为了在射频（RF）消融期间降低这些风险，已采取了多种预防措施，包括使用接触力导管、高功率短持续时间能量应用，以及诸如食管温度监测、移位装置和冷却技术等保护策略。通过监测内镜检查发现的深部食管病变被认为是更严重并发症的潜在先兆，因此值得密切关注。对此类病变患者加强监测对于实现早期诊断和及时干预以防止进展为更严重并发症可能至关重要。虽然对食管和其他周围结构风险较低的脉冲场消融疗法尚未广泛应用，但实施强有力的监测策略可在RF AF消融背景下显著改善临床结果并提高患者安全性。
