Short-term natural course of esophageal thermal injury after ablation for atrial fibrillation.
Short-term natural course of esophageal thermal injury after ablation for atrial fibrillation.
复制标题
房颤消融后食管热损伤的短期自然过程。
DOI：
10.1111/jce.15553
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发表时间：
2022-07
影响因子：
2.7
通讯作者：
Ranjan, Ravi
中科院分区：
文献类型：
--
作者：
Ishidoya, Yuki;Kwan, Eugene;Dosdall, Derek J.;Macleod, Rob S.;Navaravong, Leenhapong;Steinberg, Benjamin A.;Bunch, T. Jared;Ranjan, Ravi
关键词：
目的探讨食管胃十二指肠镜下射频导管消融（RFCA）治疗心房纤颤（AF）后食管热损伤（ETI）的短期自然历史。我们根据消融后MRI的食管晚期钆增强（LGE）来筛选接受RFCA的患者是否有房颤和EGD。包括诊断为EGD的ETI患者。我们根据堪萨斯城分类（KCC）定义ETI的严重程度：1型：红斑；2型：溃疡（2a：浅表；2b：深部）；3型穿孔（3a：穿孔；3b：穿孔合并房食管瘘）。如果推荐，在最后一次EGD后1-14天内重复进行EGD，直到观察到任何一定的愈合迹象（可见大小缩小，未加深ETI或完全消退）。378例RFCA术后EGD患者中有62例出现ETI。在这62例ETI患者中，21%（13例）在初始EGD时为1型，50%（31例）为2a型，29%（18例）为2b型。所有食管病变，除了一个2b型病变发展为心房食管瘘（AEF），在手术后14天内的重复EGD研究中都显示出愈合的迹象。一个2b型病变发展为AEF，在手术后8天的重复EGD中显示大小增加和溃疡加深。我们发现所有未进展为急性食管穿孔的ETI在术后14天内出现愈合迹象，ETI恶化可能是发生食管穿孔的早期信号。
To provide insight into the short-term natural history of esophageal thermal injury (ETI) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) by esophagogastroduodenoscopy (EGD). We screened patients who underwent RFCA for AF and EGD based on esophageal late gadolinium enhancement (LGE) in post ablation MRI. Patients with ETI diagnosed with EGD were included. We defined severity of ETI according to Kansas City classification (KCC): type 1: erythema; type 2: ulcers (2a: superficial; 2b deep); type 3 perforation (3a: perforation; 3b: perforation with atrioesophageal fistula). Repeated EGD was performed within 1–14 days after the last EGD if recommended and possible until any certain healing signs (visible reduction in size without deepening of ETI or complete resolution) were observed. ETI was observed in 62 of 378 patients who underwent EGD after RFCA. Out of these 62 patients with ETI, 21% (13) were type 1, 50% (31) were type 2a and 29% (18) were type 2b at the initial EGD. All esophageal lesions, but one type 2b lesion that developed into an atrioesophageal fistula (AEF), showed signs of healing in repeated EGD studies within 14 days after the procedure. The one type 2b lesion developing into an AEF showed an increase in size and ulcer deepening in repeat EGD 8 days after the procedure. We found that all ETI which didn’t progress to AEF presented healing signs within 14 days after the procedure and that worsening ETI might be an early signal for developing esophageal perforation.
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