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The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Atrioesophageal fistula (AEF) is an infrequent complication of radiofrequency (RF) ablation for atrial fibrillation (AF). The aim of this study was to determine the prevalence and operator-dependent factors associated with AEF using a nationwide survey of electrophysiologists (EP).

Methods

Thirty-eight EPs performing AF ablation between 2008 and 2012 were invited to complete a web-based questionnaire assessing the prevalence and factors associated with AEF.

Results

Responses were obtained from 25 EPs (68 %) accounting for 7,016 AF ablations. Five cases of proven AEF (0.07 %) were reported. Operators who reported AEF [AEF (+)] more often used general anesthesia (GA) [90 % AEF (+) vs. 44 % AEF (−), p = 0.046]. AEF (+) operators were also more likely to be users of the non-brushing technique in the posterior wall of the LA [5 (100 %) AEF (+) vs. 5 (25 %) AEF (−), p = 0.005]. The combined usage of GA and non-brushing technique during LA posterior wall ablation had a strong association with AEF (+) operators [4 (80 %) AEF (+) vs. 2 (10 %) AEF (−), p = 0.002]. There was a trend towards higher maximal RF energy setting in the posterior wall [47.4 + 7.6 AEF (+) vs. 40.2 + 8 AEF (−), p = 0.09]. Other procedure parameters were similar.

Conclusions

The reported prevalence of AEF among Canadian AF ablators is 0.07 %. AEF was associated with high mortality. The use of GA and non-brushing movements during posterior wall ablation were two factors associated with AEF.

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Abbreviations

AF:

Atrial fibrillation

AEF:

Atrioesophageal fistula

EP:

Electrophysiologists

LET:

Luminal esophageal temperature

LA:

Left atrium

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Acknowledgments

We would like to acknowledge all the operators who have contributed to this survey. In particular, Dr. Damian Redfearn, Dr. Laurence Sterns, Dr. George Veenhuyzen, Dr. Lorne Gula, Dr. Isabelle Greiss, Dr. Alexander Tischenko, and Dr. Jean-François Roux.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Krishna Kumar Mohanan Nair, Mohammed Shurrab, Asaf Danon, Ilan Lashevsky, Sheldon M. Singh & Eugene Crystal

  2. London Health Sciences Centre, London, ON, Canada

    Allan Skanes

  3. University of Ottawa Heart Institute, Ottawa, ON, Canada

    David Birnie

  4. Arrhythmia Services, McMaster University, Hamilton, ON, Canada

    Carlos Morillo

  5. Division of Cardiology, University Health Network, Toronto, Canada

    Vijay Chauhan

  6. Division of Cardiology, St Michael’s Hospital, Toronto, Canada

    Iqwal Mangat

  7. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Felix Ayala-Paredes

  8. Quebec Heart and Lung Institute, Quebec City, QC, Canada

    Jean Champagne & Isabelle Nault

  9. Royal Jubilee Hospital, Victoria, BC, Canada

    Anthony Tang

  10. Southlake Regional Health Centre, Newmarket, ON, Canada

    Atul Verma

  11. Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite D-377, Toronto, ON, M4N 3M5, Canada

    Eugene Crystal

Authors
  1. Krishna Kumar Mohanan Nair
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  2. Mohammed Shurrab
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  3. Allan Skanes
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  4. Asaf Danon
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  5. David Birnie
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  6. Carlos Morillo
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  7. Vijay Chauhan
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  8. Iqwal Mangat
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  9. Felix Ayala-Paredes
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  10. Jean Champagne
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  11. Isabelle Nault
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  12. Anthony Tang
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  13. Atul Verma
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  14. Ilan Lashevsky
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  15. Sheldon M. Singh
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  16. Eugene Crystal
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Corresponding author

Correspondence to Eugene Crystal.

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Nair, K.K.M., Shurrab, M., Skanes, A. et al. The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience. J Interv Card Electrophysiol 39, 139–144 (2014). https://doi.org/10.1007/s10840-013-9853-z

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  • DOI: https://doi.org/10.1007/s10840-013-9853-z

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