title: Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation.
abstract: OBJECTIVE
  Oesophageal injury has been reported with delivery of radio-frequency lesions at the left atrium posterior wall in catheter ablation procedures for atrial fibrillation (AF). In this observational study we prospectively assessed endoscopical oesophageal wall changes after pulmonary vein antrum isolation (PVAI) in patients presenting for treatment of AF.
  
  
  RESULTS
  Twenty eight patients (18 men; mean age 55 +/- 11 years) were ablated using either a cooled-tip or an 8 mm tip ablation catheter. Endoscopy of the oesophagus was performed 24 h after PVAI. If oesophageal wall changes were detected post ablation, a proton-pump inhibitor (PPI) was started and repeat endoscopy was considered. Within 24 h post ablation oesophageal wall changes were confirmed in 47% of our study patients. Erythema was identified in 29% and necrotic or ulcer-like changes in 18% of patients. None of study patients experienced left atrial-oesophageal fistula. A significant correlation between Reflux-like symptoms and oesophageal wall changes was demonstrated. Complete recovery of oesophageal lesions was shown in all study patients 2-4 weeks post ablation.
  
  
  CONCLUSIONS
  A significant number of patients experienced oesophageal wall injury post PVAI. Initiating PPIs in this group of patients might facilitate recovery of oesophageal wall injuries caused by radio-frequency energy delivery.
authors.affiliation: Division of Cardiology, Klinikum Coburg, Coburg, Germany. mschmidtco@arcor.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Harald
authors.initials: H
authors.lastname: Marschang
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Volker
authors.initials: V
authors.lastname: Schibgilla
authors.forename: Harald
authors.initials: H
authors.lastname: Rittger
authors.forename: Anil-Martin
authors.initials: AM
authors.lastname: Sinha
authors.forename: Guido
authors.initials: G
authors.lastname: Ritscher
authors.forename: Dirk
authors.initials: D
authors.lastname: Mayer
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004724:Endoscopy; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins