Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
A predictive model for esophageal thermal injury following atrial fibrillation ablation : Risk tool for esophageal thermal injury.
СтатьяНазвание и аннотация: Перевод в очереди
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Borges Anibal Pires, Kalil Carlos, Brugada Josep, Yanez José Plutarco Gutiérrez, Soliz Pablo da Costa, Boff Celine de Oliveira, Orsato Pedro, Saldanha Priscilla Ferreira, Rösler Álvaro, de Mattos Angelo Zambam, Saffi Marco Aurelio Lumertz, da Silveira Anderson Donelli, Pimentel Maurício
Аннотация
BACKGROUND AND AIMS: Atrioesophageal fistula (AEF) is a rare but serious complication of atrial fibrillation (AF) ablation, linked to high morbidity and mortality. Esophageal thermal injury (ETI), a precursor to AEF, highlights the need to identify high-risk patients. This study aims to assess predictors of ETI following AF ablation.
METHODS: This prospective cohort study included patients undergoing their first radiofrequency AF ablation between October 2018 and June 2024. Esophageal temperature was continuously monitored using a multi-sensor probe. RF energy on the posterior left atrial (LA) wall was delivered at 40 W for up to 12 s and interrupted if temperature reached ≥ 38 °C. Upper endoscopy within 48 h post-procedure classified ETI according to the Kansas City Classification.
RESULTS: A total of 391 patients were included (mean age 61 ± 12 years; 73% male; 71% with paroxysmal AF; CHA₂DS₂-VASc 1.7 ± 1.4). Mean LA diameter was 42 ± 6 mm, and mean left ventricular ejection fraction was 63 ± 9%. In addition to pulmonary vein isolation, 16% underwent additional ablation lines. ETI occurred in 42 patients (10.7%). Multivariable analysis showed LA diameter as a protective factor (OR 0.920, 95% CI 0.870-0.974, p = 0.004) and higher esophageal temperature as a risk factor (OR 1.813, 95% CI 1.354-2.428, p < 0.001). A predictive model combining both variables stratified patients into low- and high-risk groups (AUC 0.749). All injuries were managed conservatively without progression to AEF.
CONCLUSIONS: Smaller LA diameter and elevated esophageal temperature during AF ablation independently predict ETI.
METHODS: This prospective cohort study included patients undergoing their first radiofrequency AF ablation between October 2018 and June 2024. Esophageal temperature was continuously monitored using a multi-sensor probe. RF energy on the posterior left atrial (LA) wall was delivered at 40 W for up to 12 s and interrupted if temperature reached ≥ 38 °C. Upper endoscopy within 48 h post-procedure classified ETI according to the Kansas City Classification.
RESULTS: A total of 391 patients were included (mean age 61 ± 12 years; 73% male; 71% with paroxysmal AF; CHA₂DS₂-VASc 1.7 ± 1.4). Mean LA diameter was 42 ± 6 mm, and mean left ventricular ejection fraction was 63 ± 9%. In addition to pulmonary vein isolation, 16% underwent additional ablation lines. ETI occurred in 42 patients (10.7%). Multivariable analysis showed LA diameter as a protective factor (OR 0.920, 95% CI 0.870-0.974, p = 0.004) and higher esophageal temperature as a risk factor (OR 1.813, 95% CI 1.354-2.428, p < 0.001). A predictive model combining both variables stratified patients into low- and high-risk groups (AUC 0.749). All injuries were managed conservatively without progression to AEF.
CONCLUSIONS: Smaller LA diameter and elevated esophageal temperature during AF ablation independently predict ETI.