Ablation Approaches and Imaging Modalities to Lower Risk of Atrioesophageal Injury During Catheter Ablation for Atrial Fibrillation

AbstractPurpose of ReviewAtrioesophageal fistula (AEF) is a rare yet catastrophic complication of atrial fibrillation (AF) ablation. Limited data exists on measures to prevent AEF. This review focuses on AF ablation approaches, esophageal protective strategies, and imaging modalities that can be utilized to reduce the risk of AEF.Recent FindingsAEF has been reported to occur in less than 0.1% of AF ablation cases. Left untreated, it is associated with 100% mortality. Diagnosing AEF requires a high index of suspicion as symptoms are usually nonspecific. Several AF ablation techniques might reduce the risk of esophageal thermal injury (ETI): high-power short-duration radiofrequency ablation, implementation of time-to-isolation ablation strategy with cryoablation, and electroporation. Various esophageal protective approaches have been investigated. Although luminal esophageal temperature monitoring is widely used, data on its efficacy is conflicting. Esophageal cooling and esophageal deviation strategies have been shown to be effective in reducing the risk of ETI. Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) is a noninvasive imaging modality that seems to have high sensitivity for detecting and quantifying the degree of ETI.SummaryVariable approaches have been reported to reduce the risk of esophageal injury. These approaches focus mainly on modulating ablation parameters and esophageal luminal temperature. Imaging modalities such as LGE-MRI can potentially i...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research