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Background and aims <p> Atrioesophageal fistula (AEF) is a rare but serious complication of atrial fibrillation (AF) ablation, linked to high morbidity and mortality. Esophageal thermal injury (ETI), a precursor to AEF, highlights the need to identify high-risk patients. This study aims to assess predictors of ETI following AF ablation.</p> Methods <p>This prospective cohort study included patients undergoing their first radiofrequency AF ablation between October 2018 and June 2024. Esophageal temperature was continuously monitored using a multi-sensor probe. RF energy on the posterior left atrial (LA) wall was delivered at 40&#xa0;W for up to 12&#xa0;s and interrupted if temperature reached ≥ 38&#xa0;°C. Upper endoscopy within 48&#xa0;h post-procedure classified ETI according to the Kansas City Classification.</p> Results <p>A total of 391 patients were included (mean age 61 ± 12 years; 73% male; 71% with paroxysmal AF; CHA₂DS₂-VASc 1.7 ± 1.4). Mean LA diameter was 42 ± 6&#xa0;mm, and mean left ventricular ejection fraction was 63 ± 9%. In addition to pulmonary vein isolation, 16% underwent additional ablation lines. ETI occurred in 42 patients (10.7%). Multivariable analysis showed LA diameter as a protective factor (OR 0.920, 95% CI 0.870–0.974, <i>p</i> = 0.004) and higher esophageal temperature as a risk factor (OR 1.813, 95% CI 1.354–2.428, <i>p</i> &lt; 0.001). A predictive model combining both variables stratified patients into low- and high-risk groups (AUC 0.749). All injuries were managed conservatively without progression to AEF.</p> Conclusions <p>Smaller LA diameter and elevated esophageal temperature during AF ablation independently predict ETI.</p> Graphical Abstract <p></p>

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A predictive model for esophageal thermal injury following atrial fibrillation ablation

  • 期刊论文

  • 发表日期：

    2025年11月5日

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  • Anibal Pires Borges,
  • Carlos Kalil,
  • Josep Brugada,
  • José Plutarco Gutiérrez Yanez,
  • Pablo da Costa Soliz,
  • Celine de Oliveira Boff,
  • Pedro Orsato,
  • Priscilla Ferreira Saldanha,
  • Álvaro Rösler,
  • Angelo Zambam de Mattos,
  • Marco Aurelio Lumertz Saffi,
  • Anderson Donelli da Silveira,
  • Maurício Pimentel

摘要

Background and aims

Atrioesophageal fistula (AEF) is a rare but serious complication of atrial fibrillation (AF) ablation, linked to high morbidity and mortality. Esophageal thermal injury (ETI), a precursor to AEF, highlights the need to identify high-risk patients. This study aims to assess predictors of ETI following AF ablation.

Methods

This prospective cohort study included patients undergoing their first radiofrequency AF ablation between October 2018 and June 2024. Esophageal temperature was continuously monitored using a multi-sensor probe. RF energy on the posterior left atrial (LA) wall was delivered at 40 W for up to 12 s and interrupted if temperature reached ≥ 38 °C. Upper endoscopy within 48 h post-procedure classified ETI according to the Kansas City Classification.

Results

A total of 391 patients were included (mean age 61 ± 12 years; 73% male; 71% with paroxysmal AF; CHA₂DS₂-VASc 1.7 ± 1.4). Mean LA diameter was 42 ± 6 mm, and mean left ventricular ejection fraction was 63 ± 9%. In addition to pulmonary vein isolation, 16% underwent additional ablation lines. ETI occurred in 42 patients (10.7%). Multivariable analysis showed LA diameter as a protective factor (OR 0.920, 95% CI 0.870–0.974, p = 0.004) and higher esophageal temperature as a risk factor (OR 1.813, 95% CI 1.354–2.428, p < 0.001). A predictive model combining both variables stratified patients into low- and high-risk groups (AUC 0.749). All injuries were managed conservatively without progression to AEF.

Conclusions

Smaller LA diameter and elevated esophageal temperature during AF ablation independently predict ETI.

Graphical Abstract