Prevention of oesophageal injury during catheter ablation of atrial fibrillation: is monitoring of oesophageal temperature the solution?

Abstract

This editorial refers to ‘Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system’ by A. Rillig et al. , Europace 2010;12:655–61. Atrio-oesophageal fistula is among the most dangerous complications of interventional treatment of atrial fibrillation. The complication was first observed during intraoperative radiofrequency ablation of atrial fibrillation1 but subsequently also reported after catheter based radiofrequency ablation of atrial fibrillation.2 Atrio-oesophageal fistula is associated with high mortality3 even if the correct diagnosis is made relatively early. However, the diagnosis of the complication often is delayed because of the significant time delay of its occurrence after the ablation procedure (which mostly is 1–4 weeks) and unspecific initial symptoms.3,4 The mechanism most likely leading to atrio-oesophageal fistula after radiofrequency ablation of atrial fibrillation is the induction of thermal oesophageal injury during the ablation procedure; this pathophysiologic pathway could recently be observed in a patient who declined intervention after diagnosis of atrio-oesophageal fistula.4 The incidence of oesophageal injury after radiofrequency ablation of atrial fibrillation has been described between 5% and almost 50%5–7 depending on the radiofrequency power settings and ablation strategies. After the initial injury of the oesophagus, inflammation, and tissue necrosis promoted by the biological milieu in the oesophagus seem to pave the way for the occurrence of atrio-esophagel fistula. However, it is unclear which factors determine the progression of the frequently observed oesophageal lesion to the relatively rare but …