Esophageal Injury and Progression to Atrial-Esophageal Fistula in Catheter Ablation for Atrial Fibrillation

摘要

Purpose of Review Atrioesophageal fistula (AEF) is one of the most dreaded complications of atrial fibrillation (AFib) catheter ablation (CA) associated with high morbidity and mortality. In this review, we provide the latest evidence on the factors associated with esophageal thermal injury associated with CA, including discussion of strategies used in mitigating the risk of progression to AEF. We also discuss future directions and advances in ablation technologies that promise to further reduce the risk of this deadly complication. Recent Findings Radiofrequency point-by-point ablation guided by electroanatomic mapping is the most common CA technique. Conventional CA using low-power long-duration lesions is now being replaced by high-power short-duration (HPSD) ablation that is proven to create more durable lesions with less incidence of esophageal thermal injury. Luminal esophageal temperature (LET) monitoring using the novel multi-sensor probe (MSP) offers a better thermodynamic profile when compared to single sensor probe (SSP). Furthermore there has been a leap in the innovation of multimodality imaging which is now incorporated as a screening tool post ablation for prognostication and early preventative measures for AEF. Finally, new emerging ablation techniques including pulsed field electroporation and "one-shot" ablation are under clinical trials and may show promising results. The integration of multiple strategies at different stages of AFib CA may help mitigate the risk of AEF in the future. These strategies include the use of HPSD ablation and MSP for LET monitoring as well as the integration of imaging as a screening tool post ablation.