Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation
Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation
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DOI：
10.1016/j.hrthm.2018.09.027
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发表时间：
2019-02-01
期刊：
影响因子：
5.5
通讯作者：
Lakkireddy, Dhanunjaya
中科院分区：
文献类型：
--
作者：
Yarlagadda, Bharath;Deneke, Thomas;Lakkireddy, Dhanunjaya
背景 目前，对于房颤 (AF) 消融后食管损伤的发病、自然进展和处理知之甚少。 目的 我们试图对 AF 消融后食管损伤进行系统评价，并确定各种类型的食管损伤、其进展和临床结果之间的时间关系。 方法 截至 2017 年 9 月 21 日，对 PubMed 和 Web of Science 进行了全面检索。所有 AF 包括在手术后 1 周内接受上消化道内窥镜检查的消融患者。采用我们新的堪萨斯城分类法将食管病变患者分为 3 类： 1 型：红斑； 2a型：浅表溃疡； 2b型：深部溃疡； 3a型：穿孔不与心房相通； 3b 型：穿孔伴房食管瘘。 结果 30 项研究符合我们的纳入标准。在 4473 名患者中，3921 名接受了上消化道评估。食管损伤的总体发生率为 15% (570)。 1 型病变 206 个（36%），2a 型病变 222 个（39%），2b 型病变 142 个（25%）。 142 个 2b 型病变中有 6 个（4.2%）进一步进展为 3 型，其中 5 个为 3a 型，1 个为 3b 型。所有 1 型和 2a 型以及大多数 2b 型病变均通过保守治疗得到缓解。 1 例 3a 型病变和 1 例 3b 型病变致命。结论 根据我们的分类，所有 1 型病变和大多数 2 型病变均通过保守治疗得到缓解。一小部分（4.2% [142 例中的 6 例]）2b 型病变进展为穿孔和/或瘘管形成，需要对这些患者进行密切随访。
BACKGROUND Currently, little is known about the onset, natural progression, and management of esophageal injuries after atrial fibrillation (AF) ablation.OBJECTIVES We sought to provide a systematic review on esophageal injury after AF ablation and identify temporal relationships between various types of esophageal lesions, their progression, and clinical outcomes.METHODS A comprehensive search of PubMed and Web of Science was conducted until September 21, 2017. All AF ablation patients who underwent upper gastrointestinal endoscopy within 1 week of the procedure were included. Patients with esophageal lesions were classified into 3 types by using our novel Kansas City classification: type 1: erythema; type 2a: superficial ulcers; type 2b: deep ulcers; type 3a: perforation without communication with the atria; and type 3b: perforation with atrioesophageal fistula.RESULTS Thirty studies met our inclusion criteria. Of the 4473 patients, 3921 underwent upper gastrointestinal evaluation. The overall incidence of esophageal injuries was 15% (570). There were 206 type 1 lesions (36%), 222 type 2a lesions (39%), and 142 type 2b lesions (25%). Six of 142 type 2b lesions (4.2%) progressed further to type 3, of which, 5 were type 3a and 1 was type 3b. All type 1 and type 2a and most type 2b lesions resolved with conservative management. One type 3a and 1 type 3b lesions were fatal.CONCLUSION Based on our classification, all type 1 and most type 2 lesions resolved with conservative management. A small percentage (4.2% [6 of 142]) of type 2b lesions progressed to perforation and/or fistula formation, and these patients need to be followed closely.