Risk of atrioesophageal fistula formation with contact force-sensing catheters.

Journal Article (Journal Article)

BACKGROUND: Atrioesophageal fistula formation is a rare but life-threatening complication of atrial fibrillation ablation. Contact force (CF)-sensing catheters improve procedural effectiveness. However, the impact of the implementation of CF-sensing technology on the risk of atrioesophageal fistula formation has not been explored. OBJECTIVE: The purpose of this study was to determine the association between the use of CF-sensing catheters and atrioesophageal fistula development. METHODS: We searched the Manufacturer and User Facility Device Experience database for adverse event reports involving Food and Drug Administration-approved ablation catheters. RESULTS: Among 2689 device reports, we identified 78 atrioesophageal fistula cases, 65 of which involved CF-sensing catheters and 13 non-CF-sensing catheters. The percentage of total reports involving atrioeosphageal fistula was 5.4% for CF-sensing catheters (65 of 1202) and 0.9% for non-CF-sensing catheters (13 of 1487) (P < .0001). Procedural details (CF and power settings) were not consistently reported. Esophageal temperature increases were detected in only 2.5% of cases (2 of 78). The mean time to presentation was 16 ± 9 days. Overall mortality was at least 56%, with patients who underwent surgical repair more likely to survive than those treated with stenting or no intervention. CONCLUSION: Atrioesophageal fistula formation accounted for a much higher proportion of reported adverse events with CF-sensing catheters compared with non-CF-sensing catheters. Improved understanding of the relationship between power/force delivery and esophageal damage is needed to minimize the risk of atrioesophageal fistula formation.

Full Text

Duke Authors

Cited Authors

  • Black-Maier, E; Pokorney, SD; Barnett, AS; Zeitler, EP; Sun, AY; Jackson, KP; Bahnson, TD; Daubert, JP; Piccini, JP

Published Date

  • September 2017

Published In

Volume / Issue

  • 14 / 9

Start / End Page

  • 1328 - 1333

PubMed ID

  • 28416466

Electronic International Standard Serial Number (EISSN)

  • 1556-3871

Digital Object Identifier (DOI)

  • 10.1016/j.hrthm.2017.04.024


  • eng

Conference Location

  • United States