Highlights
- •Thermal esophageal injury is a relevant side effect of atrial fibrillation ablation.
- •Endoscopy for early detection of thermal injury and impending severe complications.
- •Postinterventional endoscopy also reveals clinically relevant incidental findings.
- •Incidental endoscopic findings in a high proportion of the asymptomatic population.
- •Screening upper endoscopy seems to be reasonable in the general older population.
Abstract
Introduction
High-power short-duration ablation (HPSD) is an effective therapy for atrial fibrillation
with thermal esophageal injury as a rare but relevant side effect.
Aim and methods
In this retrospective single-center analysis we evaluated the incidence and relevance
of ablation-induced findings and the prevalence of ablation-independent incidental
gastrointestinal findings. For 15 months all patients undergoing ablation were screened
by postablation esophagogastroduodenoscopy. Pathological findings were followed up
and treated if necessary.
Results
286 consecutive patients (66±10 years; 54.9% male) were included. 19.6% of patients
showed ablation-associated alterations (10.8% esophageal lesions, 10.8% gastroparesis,
1.7% both findings). Logistic multivariable regression analysis confirmed an influence
of lower BMI on the occurrence of RFA-associated endoscopic findings (OR 0.936, 95%
CI 0.878–0.997, p<0.05). 48.3% of patients demonstrated incidental gastrointestinal findings. In 1.0%
neoplastic lesions were present, 9.4% showed precancerous lesions and in 4.2% neoplastic
lesions of unknown dignity were found requiring further diagnostics or therapy. 18.1%
of patients demonstrated findings associated with a potentially increased risk of
bleeding under anticoagulation. Patients with clinically relevant incidental findings
were significantly more often male, 68.8% vs. 49.5% (p<0.01).
Conclusion
HPSD ablation is safe, no devasting complication occurred in any patient. It resulted
in 19.6% ablation-induced thermal injury whereas incidental findings of the upper
GI tract were found in 48.3% of patients. Due to the high prevalence of 14.7% of findings
requiring further diagnostics, therapy, or surveillance in a cohort that is mimicking
the general population, screening endoscopy of the upper GI tract seems to be reasonable
in the general population.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 14, 2023
Accepted:
February 10,
2023
Received in revised form:
January 7,
2023
Received:
November 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
