Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: A systematic review and meta-analysis

Francis J. Ha, Hui Chen Han, Prash Sanders, Andrew W. Teh, David O'Donnell, Omar Farouque, Han S. Lim

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Atrio-oesophageal fistula (AOF) is a potentially lethal complication of atrial fibrillation (AF) ablation. Many studies have evaluated the presence and prevention of endoscopically-detected oesophageal lesions (EDOL) as a proxy measure for risk of AOF. This systematic review and meta-analysis sought to determine the prevalence of EDOL and effectiveness of general preventive measures during AF ablation. We searched electronic databases for studies reporting prevalence or prevention of EDOL post-AF ablation. Pooled prevalence were reported with 95% confidence intervals (CI) while studies evaluating preventive measures including oesophageal temperature monitoring (OTM), esophageal manipulation and type of anaesthesia were analyzed descriptively or by random-effects modeling. Twenty-five studies were included in the analysis. Any and ulcerated EDOL pooled prevalence was 11% (95%CI, 6-15%) and 5% (95%CI, 3-7%), respectively. In six studies, there was no difference in EDOL with or without OTM (pooled OR 1.65, 95%CI, 0.22-12.55). There was no difference using a multi-sensor versus single-sensor OTM (one study) nor when using a deflectable probe (two studies). Oesophageal displacement was associated with significant instrumentation injury in one study. Two studies evaluating Oesophageal cooling showed conflicting results. General anaesthesia was associated with more EDOL than conscious sedation in two studies. The pooled prevalence of any and ulcerated EDOL post-ablation was 11% and 5%, but varied between studies. Techniques such as OTM and oesophageal displacement or cooling have not conclusively demonstrated a reduction in EDEL, while general anaesthesia may be associated with higher EDOL risk. Further randomized data are critically needed to validate and develop measures to prevent EDOL and AOF.

LanguageEnglish
Pages80-90
Number of pages11
JournalEuropace
Volume21
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Atrial fibrillation
  • Atrio-oesophageal fistula
  • Catheter ablation
  • Meta-analysis
  • Oesophageal injury
  • Prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ha, F. J., Han, H. C., Sanders, P., Teh, A. W., O'Donnell, D., Farouque, O., & Lim, H. S. (2019). Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: A systematic review and meta-analysis. Europace, 21(1), 80-90. https://doi.org/10.1093/europace/euy121
Ha, Francis J. ; Han, Hui Chen ; Sanders, Prash ; Teh, Andrew W. ; O'Donnell, David ; Farouque, Omar ; Lim, Han S. / Prevalence and prevention of oesophageal injury during atrial fibrillation ablation : A systematic review and meta-analysis. In: Europace. 2019 ; Vol. 21, No. 1. pp. 80-90.
@article{bfda807342d64c3d8a9f74c87629768c,
title = "Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: A systematic review and meta-analysis",
abstract = "Atrio-oesophageal fistula (AOF) is a potentially lethal complication of atrial fibrillation (AF) ablation. Many studies have evaluated the presence and prevention of endoscopically-detected oesophageal lesions (EDOL) as a proxy measure for risk of AOF. This systematic review and meta-analysis sought to determine the prevalence of EDOL and effectiveness of general preventive measures during AF ablation. We searched electronic databases for studies reporting prevalence or prevention of EDOL post-AF ablation. Pooled prevalence were reported with 95{\%} confidence intervals (CI) while studies evaluating preventive measures including oesophageal temperature monitoring (OTM), esophageal manipulation and type of anaesthesia were analyzed descriptively or by random-effects modeling. Twenty-five studies were included in the analysis. Any and ulcerated EDOL pooled prevalence was 11{\%} (95{\%}CI, 6-15{\%}) and 5{\%} (95{\%}CI, 3-7{\%}), respectively. In six studies, there was no difference in EDOL with or without OTM (pooled OR 1.65, 95{\%}CI, 0.22-12.55). There was no difference using a multi-sensor versus single-sensor OTM (one study) nor when using a deflectable probe (two studies). Oesophageal displacement was associated with significant instrumentation injury in one study. Two studies evaluating Oesophageal cooling showed conflicting results. General anaesthesia was associated with more EDOL than conscious sedation in two studies. The pooled prevalence of any and ulcerated EDOL post-ablation was 11{\%} and 5{\%}, but varied between studies. Techniques such as OTM and oesophageal displacement or cooling have not conclusively demonstrated a reduction in EDEL, while general anaesthesia may be associated with higher EDOL risk. Further randomized data are critically needed to validate and develop measures to prevent EDOL and AOF.",
keywords = "Atrial fibrillation, Atrio-oesophageal fistula, Catheter ablation, Meta-analysis, Oesophageal injury, Prevention",
author = "Ha, {Francis J.} and Han, {Hui Chen} and Prash Sanders and Teh, {Andrew W.} and David O'Donnell and Omar Farouque and Lim, {Han S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/europace/euy121",
language = "English",
volume = "21",
pages = "80--90",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "1",

}

Ha, FJ, Han, HC, Sanders, P, Teh, AW, O'Donnell, D, Farouque, O & Lim, HS 2019, 'Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: A systematic review and meta-analysis', Europace, vol. 21, no. 1, pp. 80-90. https://doi.org/10.1093/europace/euy121

Prevalence and prevention of oesophageal injury during atrial fibrillation ablation : A systematic review and meta-analysis. / Ha, Francis J.; Han, Hui Chen; Sanders, Prash; Teh, Andrew W.; O'Donnell, David; Farouque, Omar; Lim, Han S.

In: Europace, Vol. 21, No. 1, 01.01.2019, p. 80-90.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Prevalence and prevention of oesophageal injury during atrial fibrillation ablation

T2 - Europace

AU - Ha, Francis J.

AU - Han, Hui Chen

AU - Sanders, Prash

AU - Teh, Andrew W.

AU - O'Donnell, David

AU - Farouque, Omar

AU - Lim, Han S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Atrio-oesophageal fistula (AOF) is a potentially lethal complication of atrial fibrillation (AF) ablation. Many studies have evaluated the presence and prevention of endoscopically-detected oesophageal lesions (EDOL) as a proxy measure for risk of AOF. This systematic review and meta-analysis sought to determine the prevalence of EDOL and effectiveness of general preventive measures during AF ablation. We searched electronic databases for studies reporting prevalence or prevention of EDOL post-AF ablation. Pooled prevalence were reported with 95% confidence intervals (CI) while studies evaluating preventive measures including oesophageal temperature monitoring (OTM), esophageal manipulation and type of anaesthesia were analyzed descriptively or by random-effects modeling. Twenty-five studies were included in the analysis. Any and ulcerated EDOL pooled prevalence was 11% (95%CI, 6-15%) and 5% (95%CI, 3-7%), respectively. In six studies, there was no difference in EDOL with or without OTM (pooled OR 1.65, 95%CI, 0.22-12.55). There was no difference using a multi-sensor versus single-sensor OTM (one study) nor when using a deflectable probe (two studies). Oesophageal displacement was associated with significant instrumentation injury in one study. Two studies evaluating Oesophageal cooling showed conflicting results. General anaesthesia was associated with more EDOL than conscious sedation in two studies. The pooled prevalence of any and ulcerated EDOL post-ablation was 11% and 5%, but varied between studies. Techniques such as OTM and oesophageal displacement or cooling have not conclusively demonstrated a reduction in EDEL, while general anaesthesia may be associated with higher EDOL risk. Further randomized data are critically needed to validate and develop measures to prevent EDOL and AOF.

AB - Atrio-oesophageal fistula (AOF) is a potentially lethal complication of atrial fibrillation (AF) ablation. Many studies have evaluated the presence and prevention of endoscopically-detected oesophageal lesions (EDOL) as a proxy measure for risk of AOF. This systematic review and meta-analysis sought to determine the prevalence of EDOL and effectiveness of general preventive measures during AF ablation. We searched electronic databases for studies reporting prevalence or prevention of EDOL post-AF ablation. Pooled prevalence were reported with 95% confidence intervals (CI) while studies evaluating preventive measures including oesophageal temperature monitoring (OTM), esophageal manipulation and type of anaesthesia were analyzed descriptively or by random-effects modeling. Twenty-five studies were included in the analysis. Any and ulcerated EDOL pooled prevalence was 11% (95%CI, 6-15%) and 5% (95%CI, 3-7%), respectively. In six studies, there was no difference in EDOL with or without OTM (pooled OR 1.65, 95%CI, 0.22-12.55). There was no difference using a multi-sensor versus single-sensor OTM (one study) nor when using a deflectable probe (two studies). Oesophageal displacement was associated with significant instrumentation injury in one study. Two studies evaluating Oesophageal cooling showed conflicting results. General anaesthesia was associated with more EDOL than conscious sedation in two studies. The pooled prevalence of any and ulcerated EDOL post-ablation was 11% and 5%, but varied between studies. Techniques such as OTM and oesophageal displacement or cooling have not conclusively demonstrated a reduction in EDEL, while general anaesthesia may be associated with higher EDOL risk. Further randomized data are critically needed to validate and develop measures to prevent EDOL and AOF.

KW - Atrial fibrillation

KW - Atrio-oesophageal fistula

KW - Catheter ablation

KW - Meta-analysis

KW - Oesophageal injury

KW - Prevention

UR - http://www.scopus.com/inward/record.url?scp=85059501141&partnerID=8YFLogxK

U2 - 10.1093/europace/euy121

DO - 10.1093/europace/euy121

M3 - Review article

VL - 21

SP - 80

EP - 90

JO - Europace

JF - Europace

SN - 1099-5129

IS - 1

ER -