Left atrioesophageal fistula following catheter ablation for atrial fibrillation: Off-bypass, primary repair using an extrapericardial approach

Introduction: Left atrioesophageal fistula is a rare but devastating complication that can occur following catheter ablation of atrial fibrillation. Methods : Fifty patients undergoing AF ablation for paroxysmal and persistent/permanent symptomatic atrial fibrillation refractory to AAD have been enrolled and randomized into 2 groups: those undergoing the procedure under conscious sedation with fentanil or midazolam (25 patients, group and those receiving general anesthesia (25 patients, group All patients underwent esophageal temperature monitoring during the procedure. Radiofrequency energy was discontinued when the luminal temperature reached 39 C. After ablation all patients had capsule endoscopy to assess the presence for endoluminal tissue damage of the esophagus. Results : The results are shown in the table below Conclusion : The use of general anesthesia increases the risk of positive esophageal findings by capsule endoscopy

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Early mortality and complications associated with catheter ablation of atrial fibrillation: analysis of the entire procedure in Korea from 2007 to 2016

EP Europace ◽

10.1093/europace/euab116.213 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

PS Yang ◽

JH Byun ◽

JH Sung ◽

B Joung

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Hemorrhagic Stroke ◽

Early Mortality ◽

Adverse Outcomes ◽

Af Ablation ◽

Management Of Complications ◽

Atrioesophageal Fistula ◽

Procedural Complications ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background There is limited data regarding the early mortality and adverse outcomes from catheter ablation of atrial fibrillation (AF) in Korea. The aim of this study was to examine the early mortality and frequency of adverse outcomes associated with AF catheter ablation from 2006 to 2016 in Korea. Methods From 2006 to 2016 in the Korean National Health Insurance Service database, 11,893 individuals underwent catheter ablation for AF. We investigated the frequency of complications and early mortality associated with AF ablation and comorbidities that led to adverse outcomes after AF ablation. Results Out of all 11,893 procedures, early mortality occurred in 38 cases (0.32%). Annual trends in AF procedural complications occurring during index admission for AF ablation decreased from 9.25% in 2006 to 6.49% in 2016 (P for trend = 0.004). The early mortality rate after AF ablation had remained unchanged between 2006 and 2016. After adjustment for age, comorbidities, and medication, procedural complications (adjusted odds ratio[aOR]: 16.1; P < 0.001), age (aOR: 1.25; P = 0.024), history of hemorrhagic stroke (aOR: 4.74; P = 0.019), and less experience with AF ablation of the hospital (aOR: 2.85; P = 0.024) were associated with early mortality. Among procedural complications, atrioesophageal fistula (aOR: 199.8; P < 0.001), access site complications (aOR: 6.08; P = 0.005), complete heart block (aOR: 11.3; P = 0.029), pneumothorax (aOR: 62.0; P < 0.001), and procedure related pneumonia (aOR: 39.0; P < 0.001) were associated with early mortality. Conclusions Procedural complications, history of hemorrhagic stroke, and less experience with AF ablation of the hospital were predictors of early mortality. Out of all complications, atrioesophageal fistual, procedure related pneumonia, and in-hospital stroke were related to early mortality. Adequate management of complications may contribute to reducing the number of early mortalty rates following AF ablation. Abstract Figure. Trend of early mortality after ablation

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