Abstract 3231: Esophageal Capsule Endoscopy: Different Findings Based On The Anesthesia Protocol

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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Faculty Opinions recommendation of Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162135.622604 ◽

2009 ◽

Author(s):

Raul Weiss

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

General Anesthesia ◽

Capsule Endoscopy ◽

Radiofrequency Catheter Ablation ◽

Conscious Sedation ◽

Esophageal Capsule

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Abstract 16605: The Effectiveness and Safety of the Esophageal Temperature Monitoring During Catheter Ablation of Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.16605 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Miwa Ito ◽

Hisanori Kanazawa ◽

Tadashi Hoshiyama ◽

Yusei Kawahara ◽

Kenichi Tsujita

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Characteristic Curve ◽

Predictive Marker ◽

Patient Characteristics ◽

Temperature Monitoring ◽

Esophageal Injury ◽

Radiofrequency Energy ◽

Esophageal Temperature ◽

Significant Difference

Introduction: Esophageal injury is known to be a serious complication occurs after catheter ablation (CA) of atrial fibrillation (AF). Hypothesis: We investigated the factors associated with the occurrence of EI after CA. Also esophageal temperature monitoring (ETM) can be useful, multiple factors such as patient characteristics and specific strategies for radiofrequency energy delivery also merit consideration. Methods: Among 508 patients who underwent CA of AF, endoscopy was performed the next day after CA to examine for EI. The incidence of EI was compared between 200 patients who done ETM (ETM group) and 308 patients who didn’t done ETM (Non-ETM group) during CA. The Shortest Distance between esophagus and posterior left atrium measured on contrast Computed Tomography (SD-CT) was also compared between both groups. Results: No differences were observed between both groups in total amount of radiofrequency energy applications. However, EI occurred more frequently in Non-ETM group (8/200 patients; 4.0 % vs 27/308 patients; 8.8 %, p=0.042). There was no significant difference in SD-CT between ETM and Non-ETM group. However, SD-CT in patients with EI was significantly shorter than SD-CT in patients without EI, both in ETM (2.4±0.7 vs 4.3±0.9 mm, p<0.001) and in Non-ETM group (2.5±0.2 vs 4.2±0.9 mm, p=0.017), respectively. Multiple regression analysis revealed that only SD-CT significantly correlated with EI. The area under a receiver operating characteristic curve using ST-CT as a predictive marker in EI patients was 0.968 (p<0.001). When the cut-off value of EI was set at 2.9mm, the sensitivity and specificity for EI diagnosis were 96.6% and 87.5%. Conclusions: The use of ETM is absolutely safe and necessary in order to prevent the occurrence of thermal EI.

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