on February 13, 2009
Published online before print February 13, 2009, doi: 10.1161/CIRCEP.108.815266
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Original Article |
Esophageal capsule endoscopy following radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared to conscious sedation
1 Texas Cardiac Arrhythmia Institute; University of Foggia; Cleveland Clinic;
2 Fundation Cardio Infantil, Bogota;
3 Texas Cardiac Arrhythmia Institute;
4 Cleveland Clinic;
5 Milan Dodig;
6 Texas Cardiac Arrhythmia Institute; Stanford University
7 E-mail: dr.natale{at}gmail.com
Background—Left atrioesophageal fistula (LAF) is a rare but devastating complication that may occur following catheter ablation of AF. We utilized capsule endoscopy to assess esophageal injury following catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation.
Methods and Results—Fifty patients undergoing AF ablation for paroxysmal symptomatic AF refractory to antiarrhythmic drugs (AAD) were enrolled and randomized: those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and one esophageal tissue damage in a single patient (4%) of group 2 (P <0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) vs patients undergoing conscious sedation (group 2), [40.6 C±1 C versus 39.6±0.8 C (p< 0.003.)]. The time to peak temperature was 9±7 sec in group 1 and 21±9 sec in group 2 and this difference was statistically significant ( P <0.001). No complication occurred during and after the administration of the pill cam and during the procedures. All esophageal lesions normalized at the two months repeat endoscopic examination.
Conclusion—The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.
Key Words: catheter ablation of atrial fibrillation • complications • esophageal injury • left atrioesophageal fistula • left atrium
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