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Left Atrial Anatomy, Energy Delivery and Esophageal Complications Associated With Ablation of Atrial Fibrillation

In this issue of the Journal, Di Biase et al.1 report on their use of capsule endoscopy in patients who underwent radiofrequency ablation of atrial fibrillation (AF). Of the 93 patients who underwent catheter ablation, 88 patients (94%) were able to perform capsule endoscopy within 24–48 hours following AF ablation using the PillCam ESO system from Given Imaging. Catheter ablation was performed under conscious sedation with insertion of an esophageal temperature probe. Energy delivery was discontinued if the esophageal temperature reached 39◦C. The mean energy delivery over the esophagus was 32.9 ± 4 W; the applications of radiofrequency energy (up to 20 seconds) were not prematurely terminated in response to pain. In 15 of 88 patients (17%), significant capsule findings were observed, and 6 of these patients (40%) also had symptoms consisting of chest, throat or abdominal pain, or nausea. Endoscopic abnormalities consisted of erosions, burns, erythema, clot, or ulcerations. These patients were treated with proton pump inhibitor therapy, and endoscopy at 3 months showed recovery in all patients.