Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience
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.
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.
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).
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.
KeywordsRemote magnetic navigation Atrial-esophageal fistula Atrial fibrillation Survey Stereotaxis
- 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: 528–606Google Scholar
- 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle Scholar