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Prevention of esophageal injury during catheter ablation of atrial fibrillation: Is intracardiac echocardiography the answer?

2006; Elsevier BV; Volume: 3; Issue: 10 Linguagem: Inglês

10.1016/j.hrthm.2006.06.019

1556-3871

Hugh Calkins,

Cardiac pacing and defibrillation studies

The field of catheter ablation of atrial fibrillation (AF) has evolved dramatically over the past decade from a highly experimental procedure performed in only a handful of electrophysiology laboratories to its role today as a widely available treatment option for AF. Indeed, catheter ablation of AF is now the most common ablation procedure performed throughout the world. Perhaps the most feared and most lethal of the many complications that have been associated with this procedure is esophageal injury with creation of an atrioesophageal fistula. 1 Pappone C. Oral H. Santinelli V. Vicedomini G. Lang C.C. Manguso F. Torracca L. Benussi S. Alfieri O. Hong R. Lau W. Hirata K. Shikuma N. Hall B. Morady F. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004; 109: 2724-2726 Crossref PubMed Scopus (758) Google Scholar , 2 Scanavacca M.I. D'Avila A. Parga J. Sosa E. Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004; 15: 960-962 Crossref PubMed Scopus (260) Google Scholar , 3 Good E. Oral H. Lemola K. Han J. Tamirisa K. Igic P. Elmouchi D. Tschopp D. Reich S. Chugh A. Bogun F. Pelosi Jr, F. Morady F. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005; 46: 2107-2110 Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar , 4 Cummings J.E. Schweikert R.A. Saliba W.I. Burkhardt J.D. Kilikaslan F. Saad E. Natale A. Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006; 144: 572-574 Crossref PubMed Scopus (188) Google Scholar In my estimation, there have been at least 60 patients worldwide who have experienced this complication, with a resultant mortality in excess of 75%.