Esophageal Thermal Injury Following Cryoballoon Ablation for Atrial Fibrillation

Area of Science:

• Cardiology
• Gastroenterology
• Medical Imaging

Background:

• Endoscopically detected esophageal thermal lesions (EDEL) are a known complication of catheter ablation for atrial fibrillation (AF).
• EDEL can lead to serious complications, including atrial esophageal fistula formation.
• Understanding the incidence and predictors of EDEL is crucial for patient safety during AF ablation procedures.

Purpose of the Study:

• To evaluate the incidence of EDEL in patients undergoing cryoballoon ablation (CBA) for AF.
• To identify clinical, anatomical, and procedural predictors associated with the development of EDEL.
• To assess the severity of EDEL detected post-CBA.

Main Methods:

• An observational study including 95 patients with AF undergoing CBA.
• Retrospective analysis of pre-procedural magnetic resonance imaging to measure atrial-esophageal distance (AED).
• Intraprocedural temperature monitoring and post-ablation upper endoscopy (EGD) at 24 hours to detect EDEL.

Main Results:

• EDEL was detected in 22% of patients, with most cases being mild.
• Univariate analysis showed gastroesophageal reflux disease increased risk, while wider AED and esophageal wall thickness were protective.
• Multivariate analysis identified obesity as increasing EDEL risk (OR: 4.63) and a wider AED as protective (OR: 0.22).

Conclusions:

• EDEL occurs in 22% of patients following CBA and is typically mild.
• Obesity and a narrower atrial-esophageal distance are independent predictors of increased EDEL risk.
• Procedural parameters like temperature and application duration did not predict EDEL.