Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation

Bharath Yarlagadda, Thomas Deneke, Mohit Turagam, Tawseef Dar, Swathi Paleti, Valay Parikh, Luigi DiBiase, Philipp Halfbass, Pasquale Santangeli, Srijoy Mahapatra, Jie Cheng, Andrea Russo, James Edgerton, Moussa Mansour, Jeremy Ruskin, Srinivas Dukkipati, David Wilber, Vivek Reddy, Douglas L Packer, Andrea Natale & 1 others Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. Objectives: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. Methods: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. Results: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. Conclusion: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Catheter Ablation
Atrial Fibrillation
Wounds and Injuries
Ulcer
Fistula
Gastrointestinal Endoscopy
Erythema
PubMed
Communication
Incidence
Conservative Treatment

Keywords

  • Atrial fibrillation
  • Atrioesophageal fistula
  • Catheter ablation/Adverse effects
  • Esophageal injuries
  • Esophageal perforation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation. / Yarlagadda, Bharath; Deneke, Thomas; Turagam, Mohit; Dar, Tawseef; Paleti, Swathi; Parikh, Valay; DiBiase, Luigi; Halfbass, Philipp; Santangeli, Pasquale; Mahapatra, Srijoy; Cheng, Jie; Russo, Andrea; Edgerton, James; Mansour, Moussa; Ruskin, Jeremy; Dukkipati, Srinivas; Wilber, David; Reddy, Vivek; Packer, Douglas L; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Heart Rhythm, 01.01.2018.

Research output: Contribution to journalArticle

Yarlagadda, B, Deneke, T, Turagam, M, Dar, T, Paleti, S, Parikh, V, DiBiase, L, Halfbass, P, Santangeli, P, Mahapatra, S, Cheng, J, Russo, A, Edgerton, J, Mansour, M, Ruskin, J, Dukkipati, S, Wilber, D, Reddy, V, Packer, DL, Natale, A & Lakkireddy, D 2018, 'Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2018.09.027
Yarlagadda, Bharath ; Deneke, Thomas ; Turagam, Mohit ; Dar, Tawseef ; Paleti, Swathi ; Parikh, Valay ; DiBiase, Luigi ; Halfbass, Philipp ; Santangeli, Pasquale ; Mahapatra, Srijoy ; Cheng, Jie ; Russo, Andrea ; Edgerton, James ; Mansour, Moussa ; Ruskin, Jeremy ; Dukkipati, Srinivas ; Wilber, David ; Reddy, Vivek ; Packer, Douglas L ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation. In: Heart Rhythm. 2018.
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abstract = "Background: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. Objectives: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. Methods: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. Results: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15{\%} (570). There were 206 type 1 lesions (36{\%}), 222 type 2a lesions (39{\%}), and 142 type 2b lesions (25{\%}). Six of 142 type 2b lesions (4.2{\%}) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. Conclusion: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2{\%} [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.",
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AU - Deneke, Thomas

AU - Turagam, Mohit

AU - Dar, Tawseef

AU - Paleti, Swathi

AU - Parikh, Valay

AU - DiBiase, Luigi

AU - Halfbass, Philipp

AU - Santangeli, Pasquale

AU - Mahapatra, Srijoy

AU - Cheng, Jie

AU - Russo, Andrea

AU - Edgerton, James

AU - Mansour, Moussa

AU - Ruskin, Jeremy

AU - Dukkipati, Srinivas

AU - Wilber, David

AU - Reddy, Vivek

AU - Packer, Douglas L

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

PY - 2018/1/1

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N2 - Background: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. Objectives: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. Methods: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. Results: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. Conclusion: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.

AB - Background: Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation. Objectives: We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes. Methods: A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula. Results: Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal. Conclusion: Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.

KW - Atrial fibrillation

KW - Atrioesophageal fistula

KW - Catheter ablation/Adverse effects

KW - Esophageal injuries

KW - Esophageal perforation

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