Skip to main content
SpringerLink
Log in

Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Remote magnetic navigation (RMN) has been used in various electrophysiological procedures, including atrial fibrillation (AF) ablation. Atrial-esophageal fistula (AEF) is one of most disastrous complications of AF ablation. We aimed to evaluate the incidence of AEF during AF ablation using RMN in comparison to manual ablation.

Methods

We conducted the first international survey among RMN operators for assessment of the prevalence of AEF and procedural parameters affecting the risk. Data from parallel survey of AEF among Canadian interventional electrophysiologists (CIE) using only manual catheters served as control.

Results

Fifteen RMN operators (who performed 3637 procedures) and 25 manual CIE operators (7016 procedures) responded to the survey. RMN operators were more experienced than CIE operators (16.3 ± 8.3 vs. 9.2 ± 5.4 practice years in electrophysiology, p = 0.007). The maximal energy output in the posterior wall was higher in the operator using RMN (33 ± 5 vs. 28.6 ± 4.9 W; p = 0.02). Other parameters including use of preprocedural images, irrigated catheter, pump flow rate, esophageal temperature monitoring, intracardiac echocardiography (ICE), and general anesthesia were similar. CIE operators administered proton-pump inhibitors postoperatively significantly more than RMN operators (76 vs. 35 %, p = 0.01). AEF was reported in 5 of the 7016 patients in the control group (0.07 %) but in none of the RMN group (p = 0.11).

Conclusions

AEF is a rare complication and its evaluation necessitates large-scale studies. Although no AEF case with RMN was reported in this large study or previously on the literature, the rarity of this complication prevents firm conclusion about the risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Darby, A. E., & DiMarco, J. P. (2012). Management of atrial fibrillation in patients with structural heart disease. Circulation, 125, 945–957.

    Article  PubMed  Google Scholar 

  2. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Europace 2012; 14: 528–606

  3. Arbelo, E., Brugada, J., Hindricks, G., Maggioni, A., Tavazzi, L., Vardas, P., Anselme, F., on behalf of the Atrial Fibrillation Ablation Pilot Study Investigators, et al. (2012). ESC-EURObservational Research Program: the Atrial Fibrillation Ablation Pilot Study, conducted by the European Heart Rhythm Association. Europace, 14, 1094–1103.

    Article  PubMed  Google Scholar 

  4. Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y. H., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111, 1100–1105.

    Article  PubMed  Google Scholar 

  5. Pappone, C., Oral, H., Santinelli, V., Vicedomini, G., Lang, C. C., Manguso, F., Torracca, L., et al. (2004). Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation, 109, 2724–2726.

    Article  PubMed  Google Scholar 

  6. Singh, S. M., d’Avila, A., Doshi, S. K., Brugge, W. R., Bedford, R. A., Mela, T., Ruskin, J. N., et al. (2008). Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circulation Arrhythmia and Electrophysiology, 1, 162–168.

    Article  PubMed  Google Scholar 

  7. Konstantinidou, M., Wissner, E., Chun, J. K. R., Koektuerk, B., Metzner, A., Tilz, R. R., Rilig, A., et al. (2011). Luminal esophageal temperature rise and esophageal lesion formation following remote-controlled magnetic pulmonary vein isolation. Heart Rhythm, 8, 1875–1880.

    Article  PubMed  Google Scholar 

  8. Chugh, A., Rubenstein, J., Good, E., Ebinger, M., Jongnarangsin, K., Fortino, J., et al. (2009). Mechanical displacement of the esophagus in patients undergoing left atrial ablation of atrial fibrillation. Heart Rhythm, 6, 319–322.

    Article  PubMed  Google Scholar 

  9. Arruda, M. S., Armaganijan, L., Biase, L. B., Rashidi, R., & Natale, A. (2009). Feasibility and safety of using an esophageal protective system to eliminate esophageal thermal injury. Journal of Cardiovascular Electrophysiology, 20, 1272.

    Article  PubMed  Google Scholar 

  10. Zellerhoff, S., Lenze, F., & Eckardt, L. (2011). Prophylactic proton pump inhibition after atrial fibrillation ablation: is there any evidence? Europace, 13, 1219–1221.

    Article  PubMed  Google Scholar 

  11. Schmidt, M., Nölker, G., Marschang, H., Gutleben, K. J., Schibgilla, V., Rittger, H., Sinha, A. M., et al. (2008). Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace, 10, 205–209.

    Article  PubMed  Google Scholar 

  12. Nair, K. K. M., Shurrab, M., Skanes, A., Danon, A., Birnie, D., Morillo, C., Chauhan, V., Mangat, I., et al. (2014). The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience. Journal of Interventional Cardiac Electrophysiology, 39, 139–144.

    Article  PubMed  Google Scholar 

  13. Ghia, K. K., Chugh, A., Good, E., Pelosi, F., Jongnarangsin, K., Bogun, F., Morady, F., et al. (2009). A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. Journal of Interventional Cardiac Electrophysiology, 24, 33–36.

    Article  PubMed  Google Scholar 

  14. Pappone, C., Vicedomini, G., Manguso, F., Gugliotta, F., Mazzone, P., Gulletta, S., Sora, N., et al. (2006). Robotic magnetic navigation for atrial fibrillation ablation. Journal of the American College of Cardiology, 47, 1390–1400.

    Article  PubMed  Google Scholar 

  15. Faddis, M. N., Chen, J., Osborn, J., Talcott, M., Cain, M. E., & Lindsay, B. D. (2003). Magnetic guidance system for cardiac electrophysiology—a prospective trial of safety and efficacy in humans. Journal of the American College of Cardiology, 42, 1952–1958.

    Article  PubMed  Google Scholar 

  16. Kim, A., Turakhia, M., Lu, J., Badhwar, N., Lee, B. K., Lee, R. J., Marcus, G. M., et al. (2008). Impact of remote magnetic catheter navigation on ablation fluoroscopy and procedure time. PACE, 31, 1399–1404.

    Article  PubMed  Google Scholar 

  17. Shurrab, M., Danon, A., Lashevsky, I., Kiss, A., Newman, D., Szili-Torok, T., & Crystal, E. (2013). Robotically assisted ablation of atrial fibrillation: a systematic review and meta-analysis. International Journal of Cardiology, 169, 157–165.

    Article  PubMed  Google Scholar 

  18. Grubina, R., Cha, Y.-M., Bell, M. R., Sinak, L. J., & Asirvatham, S. J. (2010). Pneumopericardium following radiofrequency ablation for atrial fibrillation: insights into the natural history of atrial esophageal fistula formation. Journal of Cardiovascular Electrophysiology, 21, 1046–1049.

    Article  PubMed  Google Scholar 

  19. Davis, D. R., Tang, A. S. L., Gollob, M. H., Lemery, R., Green, M. S., & Birnie, D. H. (2008). Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures. PACE, 31, 893–898.

    Article  PubMed  Google Scholar 

  20. Faddis, M. N., Blume, W., Finney, J., Hall, A., Rauch, J., Sell, J., Bae, K. T., et al. (2002). Novel, magnetically guided catheter for endocardial mapping and radiofrequency catheter ablation. Circulation, 106, 2980–2985.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Arrhythmia service, Schulich Heart Centre, Department of Cardiology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Canada

    Asaf Danon, Mohammed Shurrab, Krishnakumar Mohanan Nair, Ilan Lashevsky & Eugene Crystal

  2. Arrhythmia service, department of Cardiology, Carmel Medical Center, 7 Michal st., Haifa, Israel

    Asaf Danon

  3. Service de Cardiologie, Centre Hospitalier Princesse Grace, Monaco (Principauté), Monaco

    Decebal Gabriel Latcu

  4. Harrington-McLaughlin Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Mauricio S. Arruda

  5. Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Xu Chen

  6. Clinical Electrophysiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands

    Tamas Szili-Torok

  7. Section of Cardiology, Department of Medicine, University of Trondheim, Trondheim, Norway

    Ole Rossvol

  8. Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

    Eric E. Wissner

Authors
  1. Asaf Danon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed Shurrab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krishnakumar Mohanan Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Decebal Gabriel Latcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauricio S. Arruda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tamas Szili-Torok
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ole Rossvol
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eric E. Wissner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ilan Lashevsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eugene Crystal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asaf Danon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Danon, A., Shurrab, M., Nair, K.M. et al. Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience. J Interv Card Electrophysiol 43, 169–174 (2015). https://doi.org/10.1007/s10840-015-0003-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0003-7

Keywords

Search

Navigation