Esophageal injury with AF ablation: Rare but potentially devastating
Esophageal injury with AF ablation: Esophageal injury has remained a nightmare of atrial fibrillation ablation due to potentially catastrophic sequelae. Esophageal perforation after AF ablation can lead to atrio-esophageal fistula, pericardial-esophageal fistula or esophageal perforation without fistula. A recent global survey  showed that about 70% of esophageal perforation following AF ablation resulted in atrio-esophageal fistula. They recommend extreme vigil for this rare complication for the first two months after AF ablation and after surgical repair of esophageal perforation. Esophageal perforations do occur despite various esophageal monitoring techniques. Atrial-esophageal fistula has a mortality of nearly eighty percent. But fortunately, it is a very rare complication of AF ablation.
This was an internet based survey in which 405 (13%) of the 3080 physicians requested participated. The responding physicians had performed 191,215 AF ablations and esophageal perforation with or without fistula occurred in 31 patients (0.016%). Esophageal position or temperature had been monitored in 90% of cases.
- Barbhaiya CR, Kumar S, Guo Y, Zhong J, John RM, Tedrow UB, Koplan BA, Epstein LM, Stevenson WG, Michaud GF. Global Survey of Esophageal Injury in Atrial Fibrillation Ablation: Characteristics and Outcomes of Esophageal Perforation and Fistula. JACC Clin Electrophysiol. 2016 Apr;2(2):143-150.