Esophageal Injury Risk Factors in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Esophageal injury (EI) is a potentially serious complication of catheter ablation (CA) for atrial fibrillation (AF). However, data on its incidence and risk factors, particularly after radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA), remain limited. This study aimed to identify predictors of EI in patients undergoing RFCA and CBA.

In this retrospective study, patients with AF who underwent de novo RFCA or CBA between December 2019 and April 2022 were evaluated. All underwent EGD within 2 days post-ablation. EI severity was graded, and clinical predictors were analyzed using multivariate logistic regression.

Among 584 patients (mean age 62.8 ± 11.2 years, 68.6% male), 30 (5.1%) developed EI (RFCA: 5.0%, CBA: 6.3%). Most injuries were mild (Class I), and all resolved with proton pump inhibitor therapy. Compared with those without EI, affected patients had significantly lower body mass index (BMI) (24.5 ± 3.9 vs. 25.9 ± 3.4 kg/m², p = 0.030) and reduced ejection fraction (EF) (48.9% ± 8.7% vs. 52.8% ± 6.8%, p = 0.023). Multivariate analysis identified BMI ≤ 24 kg/m² (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.69-7.96) and EF ≤ 40% (OR, 4.08; 95% CI, 1.54-11.56) as independent risk factors.

Esophageal injury after catheter ablation for atrial fibrillation is not rare, but usually mild. Lower BMI and reduced LVEF were independent risk factors, regardless of ablation type. These results support selective endoscopic screening in high-risk patients to enable early detection and prevent severe complications.