Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster

D-PO05-123 - Lesion Level Predictors Of Esophageal Injury With Radiofrequency Ablation For Atrial Fibrillation (ID 556)

Disclosure
 S.Y. sarairah: Nothing relevant to disclose.

Abstract

Background: Esophageal thermal injury (ETI) is a known complication catheter ablation for atrial fibrillation (AF).
Objective: We sought to investigate whether radiofrequency (RF) ablation lesion related parameters are associated with ETI.
Methods: This was a retrospective analysis of patients with AF undergoing RF ablation. Lesion characteristics, including duration, contact force, impedance drop were derived from the CARTO VISITAG module. All patients underwent esophageal temperature monitoring during and esophagogastroduodenoscopy (EGD) the day after ablation. We performed logistic regression analysis to study associations with ETI.
Results: We analyzed 1539 left atrial posterior wall RF lesions in 40 patients (25 patients ablated with 35 Watts and 15 patients with 40 Watts). The average age 63.8±11.3 years; 66.0% male. ETI was found in 10 patients (25.0%). The average lesion duration was 15.1±7.6 sec in the 35 Watts groups and 10.2±3.4 sec in the 40 Watts group. The average contact force of 11.3±5.4 grams. The average force-time-integral was 168.0±110.1 g.s. Patients with ETI had a higher number of posterior wall lesions compared to those without ETI: (76.2±53.5 vs 57.7±41.7; p<0.01). Multivariate logistic regression analysis revealed that the number of lesions, and lesion time to be associated with esophageal injury (table 1). Receiver Operator Characteristics analysis showed an area under the curve of 0.74 indicating a good ability of this model in predicting ETI. Patient level analysis did not identify any clinical characteristics associated ETI.
Conclusion: ETI is common with RF ablation for AF. risk increases with the number of posterior wall lesions and lesion duration.
Predictor VariableOdds Ratio95% CIP value
Number of lesions1.021.017-1.020<0.001
Lesion Force (g)0.990.973-0.9990.040
Lesion Time (sec)1.021.007-1.027<0.001
Lesion Impedance drop (Ohms)1.010.999-1.0240.054
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