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

D-PO05-138 - Esophageal Thickness And Proximity To The Left Atrium Are Associated With Thermal Injury Following Catheter Ablation For Atrial Fibrillation (ID 563)


Background: Esophageal thermal injury (ETI) is a known complication of catheter ablation for atrial fibrillation
Objective: Determine whether the course of the esophagus and its proximity to the atrial wall predict ETI.
Methods: The course of the esophagus and proximity to the left atrial wall were determined from pre-ablation cardiac MRI scans. Thermal injury was assessed by endoscopy (EGD) the day after ablation.
Results: 169 patients underwent catheter ablation (98 with radiofrequency and 71 with cryoballoon) at the University of Washington. The average age was 65 years (35% female). The esophagus had a midline course in 41% of patients, close to the left pulmonary veins in 31% and close to the right pulmonary veins in 28%. The average distance from the atrial endocardium to the esophageal lumen was 4.6±0.6 mm. EGD revealed esophageal injury in 24.4% of patients undergoing cryoballoon (CBA), and 34.7% of patients undergoing radiofrequency ablation (RFA). The distance from the atrial endocardium to the esophageal lumen a predictor of thermal injury in CBA (OR 0.16; p=0.002) as well as RFA (OR 0.36; p=0.03). Esophageal location and prior history of gastroesophageal reflux were not predictive of thermal injury with either technique, whereas esophageal wall thickness was associated with a reduced risk of injury with both techniques (OR=0.04; p=0.04 for CBA and OR =0.02;p=004 for RFA).
Conclusion: EGD evidence of thermal injury is more common following radiofrequency than cryoballoon catheter ablation. The distance of the esophagus from the atrial endocardium and the thickness of the esophagus are protective against injury with both techniques.