Co-Author(s):
Shreya Ghetiya, MD
Allen Brown, MD
Claude Elayi, MD
Jing Xu, PhD
Fabrizio Asis, MD
Harikrishna Tandri, MD
John Catanzaro, MD
UF Health Cardiology
1505 SW Archer Road Gainesville Florida 32606
Introduction | Objectives: Atrioesophageal fistula (AEF) remains a rare and often fatal
complication of percutaneous catheter ablation of atrial fibrillation
(AF). Ablation energies include radiofrequency (RFE) cryotherapy (CTE)
and laser (LE). Although each energy modality has a different mechanism
of injury, the reports and association of energy source on the risk of
atrioesophageal injury and fistula formation after catheter ablation has
not been explored.
Methods: We searched the Manufacturer and User Facility Device Experience
database (MAUDE) for adverse events related to AF and atrial flutter
ablation procedures from 08/01/2009 to 08/31/2019
was performed. All reports were manually reviewed and e vents associated
with AEF formation and esophageal injury were included. Frequency of AEF
reporting were compared based on energy used with a Fisher exact test.
Results: Among 1274 reported device adverse events, we identified a total of
5.7% [73/1274] to have esophageal damage (fistula formation or
injury). Among these, AEF formation occurred in 4.1 % [52/1274] and
1.6 % [21/1274] were esophageal injury. Among reports with AEF,
71.2 % (37/52) occurred with radiofrequency energy (RF), 26.9%
[14/52] using cryothermal (CTE) and 1.9% [1/52] with laser
energy (LE). There was no statistical difference amongst energy sources
for esophageal damage related death or injury (p = 0.144).
Conclusions: The MAUDE database demonstrated that AEF and esophageal has been
reported in RFE, CTE and LE ablation. There was no significant
difference for the reporting of esophageal fistulas after atrial
fibrillation ablation amongst different energy ablation sources. LE is a
newer energy modality and continued vigilance is recommended especially
when using newer energy sources during ablation for AF.
Further research into the precise mechanism of AEF formation
and technological advances in esophageal protection technology is
warranted to avoid such a devastating major complication.