ABLATION FOR ATRIAL FIBRILLATION
Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation
1 Division of Cardiology, Klinikum Coburg, Coburg, Germany; 2 Division of Gastroenterology, Klinikum Coburg, Coburg, Germany; 3 Division of Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
Aims: Oesophageal injury has been reported with delivery of radio-frequency lesions at the left atrium posterior wall in catheter ablation procedures for atrial fibrillation (AF). In this observational study we prospectively assessed endoscopical oesophageal wall changes after pulmonary vein antrum isolation (PVAI) in patients presenting for treatment of AF.
Methods and results: Twenty eight patients (18 men; mean age 55 ± 11 years) were ablated using either a cooled-tip or an 8 mm tip ablation catheter. Endoscopy of the oesophagus was performed 24 h after PVAI. If oesophageal wall changes were detected post ablation, a proton-pump inhibitor (PPI) was started and repeat endoscopy was considered. Within 24 h post ablation oesophageal wall changes were confirmed in 47% of our study patients. Erythema was identified in 29% and necrotic or ulcer-like changes in 18% of patients. None of study patients experienced left atrial-oesophageal fistula. A significant correlation between Reflux-like symptoms and oesophageal wall changes was demonstrated. Complete recovery of oesophageal lesions was shown in all study patients 2–4 weeks post ablation.
Conclusion: A significant number of patients experienced oesophageal wall injury post PVAI. Initiating PPIs in this group of patients might facilitate recovery of oesophageal wall injuries caused by radio-frequency energy delivery.
Key Words: Oesophageal injury, Radio-frequency catheter ablation, Pulmonary vein antrum isolation, Proton-pump inhibitor
* Corresponding author. Tel: +49 9561 2233223. E-mail address: mschmidtco{at}arcor.de
Manuscript submitted 2 July 2007. Accepted after revision 28 December 2007.
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