The esophageal temperature probe: helpful monitoring device or inadvertent amplifier of risk?

摘要

Catheter ablation targeting the pulmonary veins or left atrial substrate, or both, has become an established strategy for the management of patients with drug refractory, symptomatic atrial fibrillation (AF). The number of AF ablation procedures has doubled in the past 4 years; in 2008, an estimated 80,000 AF ablation procedures were performed in the United States alone. Despite the increasing number of patients undergoing catheter ablation of AF, fundamental questions remain regarding procedural efficacy and safety.Atrioesophageal (AE) fistula is a rare but dreaded and devastating complication of catheter ablation for AF. Although the reported incidence is only about 0.03-0.2%, the resultant mortality is in excess of 75%.'~3 Since the initial reports of this complication, an intense effort has been undertaken to understand the pathophysiology underlying this condition and to develop means to prevent this complication. What is now apparent is that the A-E fistula is just the "tip of the iceberg."4 Milder forms of esophageal injury that range from esophageal erythema to intramural hemorrhage to frank esophageal ulcers can occur in a significant number of patients undergoing catheter ablation of AF.