title: The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience.
abstract: OBJECTIVE
  Atrioesophageal fistula (AEF) is an infrequent complication of radiofrequency (RF) ablation for atrial fibrillation (AF). The aim of this study was to determine the prevalence and operator-dependent factors associated with AEF using a nationwide survey of electrophysiologists (EP).
  
  
  METHODS
  Thirty-eight EPs performing AF ablation between 2008 and 2012 were invited to complete a web-based questionnaire assessing the prevalence and factors associated with AEF.
  
  
  RESULTS
  Responses were obtained from 25 EPs (68 %) accounting for 7,016 AF ablations. Five cases of proven AEF (0.07 %) were reported. Operators who reported AEF [AEF (+)] more often used general anesthesia (GA) [90 % AEF (+) vs. 44 % AEF (-), p = 0.046]. AEF (+) operators were also more likely to be users of the non-brushing technique in the posterior wall of the LA [5 (100 %) AEF (+) vs. 5 (25 %) AEF (-), p = 0.005]. The combined usage of GA and non-brushing technique during LA posterior wall ablation had a strong association with AEF (+) operators [4 (80 %) AEF (+) vs. 2 (10 %) AEF (-), p = 0.002]. There was a trend towards higher maximal RF energy setting in the posterior wall [47.4 + 7.6 AEF (+) vs. 40.2 + 8 AEF (-), p = 0.09]. Other procedure parameters were similar.
  
  
  CONCLUSIONS
  The reported prevalence of AEF among Canadian AF ablators is 0.07 %. AEF was associated with high mortality. The use of GA and non-brushing movements during posterior wall ablation were two factors associated with AEF.
authors: Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors: Krishna Kumar Mohanan
authors: KK
authors: Nair
authors: Mohammed
authors: M
authors: Shurrab
authors: Allan
authors: A
authors: Skanes
authors: Asaf
authors: A
authors: Danon
authors: David
authors: D
authors: Birnie
authors: Carlos
authors: C
authors: Morillo
authors: Vijay
authors: V
authors: Chauhan
authors: Iqwal
authors: I
authors: Mangat
authors: Felix
authors: F
authors: Ayala-Paredes
authors: Jean
authors: J
authors: Champagne
authors: Isabelle
authors: I
authors: Nault
authors: Anthony
authors: A
authors: Tang
authors: Atul
authors: A
authors: Verma
authors: Ilan
authors: I
authors: Lashevsky
authors: Sheldon M
authors: SM
authors: Singh
authors: Eugene
authors: E
authors: Crystal
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D017115:Catheter Ablation / Q000401:mortality*; D015984:Causality; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015897:Comorbidity; D004937:Esophageal Fistula / Q000401:mortality*; D005260:Female; D019538:Health Care Surveys; D006325:Heart Atria; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate