title: Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation.
abstract: BACKGROUND
  Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation.
  
  
  RESULTS
  Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6+/-1 degrees C versus 39.6+/-0.8 degrees C; P< 0.003). The time to peak temperature was 9+/-7 seconds in group 1 and 21+/-9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination.
  
  
  CONCLUSIONS
  The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas 78705, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Saenz
authors.forename: David J
authors.initials: DJ
authors.lastname: Burkhardt
authors.forename: Miguel
authors.initials: M
authors.lastname: Vacca
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Alan
authors.initials: A
authors.lastname: Siu
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Fahmy
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Luciana
authors.initials: L
authors.lastname: Armaganijan
authors.forename: Chia Tung
authors.initials: CT
authors.lastname: Wu
authors.forename: Sonne
authors.initials: S
authors.lastname: Kai
authors.forename: Ching Keong
authors.initials: CK
authors.lastname: Ching
authors.forename: Karen
authors.initials: K
authors.lastname: Phillips
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arruda
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: Milan
authors.initials: M
authors.lastname: Dodig
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001281:Atrial Fibrillation / Q000601:surgery*; D002058:Burns, Electric / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D053705:Capsule Endoscopes; D053704:Capsule Endoscopy; D017115:Catheter Ablation / Q000009:adverse effects*; D016292:Procedural Sedation; D004937:Esophageal Fistula / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D012307:Risk Factors; D013696:Temperature