Author + information
- Nischala Nannapanenia,b,
- Michelle Silvera,b,
- Gagandeep Kaura,b,
- K. Cho Williama,b,
- Mohamed Labedia,b,
- Stephen Rechenmachera,b,
- Frederick Hana,b,
- Mihail Chelua,b and
- Nassir Marrouchea,b
Background: Atrioesophageal fistula is a well-recognized complication of catheter ablation of atrial fibrillation (AF) with a reported incidence of 0.015-0.2%. Careful screening with Magnetic resonance imaging (MRI) and Esophagogastroduodenosopy (EGD) may help avoid this potentially lethal complication.
Methods: A protocol-guided approach to esophageal screening using MRI was employed in patients within 72 hours of catheter ablation. Patients with contraindication to MRI, or abnormal esophageal enhancement on initial MRI, underwent EGD. Abnormal EGD findings were treated by withholding oral intake of food and fluids, intravenous Proton-pump inhibitor and antiulcer medications in conjunction with repeat EGD prior to discharge
Results: 1,497 patients underwent catheter ablation of AF at our institution from 10/2010 to 09/2016. Post ablation, MRI was performed in 1,130 patients, EGD in 17, and 350 forwent screening due to varied reasons. After initial assessment, 149 (12.9%) displayed abnormal enhancement, and underwent repeat MRI per protocol. Following repeat MRI, 30 patients (2.6%) underwent EGD due to persistent esophageal injury pattern on MRI. Of the 47 patients who underwent EGD, 4 (0.3%) had abnormal findings prompting treatment. On long term follow up, no cases of atrioesophageal fistulas were noted.
Conclusions: Early detection of esophageal injury with MRI and EGD triggers more intensive treatment, which has the potential to avoid esophageal complications.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: Basic 2
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1152-115
- 2017 American College of Cardiology Foundation