Gastrointestinal complications associated with catheter ablation for atrial fibrillation

Several ablation methods and techniques have been described to minimize the incidence of thermal injuries to the neighboring structures, involves:
- Image the esophagus and its relation to LA wall pre-ablation.
- Prescribe proton pump inhibitors before and after the ablation
- Monitor luminal esophageal temperature and limit energy delivery to 25-30 W
- Mechanical deflect esophagus or perform esophageal cooling with cold saline
- Esophageal isolation using intra-pericardial balloon

Atrial fibrillation is the most common arrhythmia in the United States. With the ageing population, the incidence and prevalence of atrial fibrillation are on the rise. Catheter ablation of atrial fibrillation is a widely accepted treatment modality in patients with drug refractory symptomatic paroxysmal or persistent atrial fibrillation. The close proximity to the left atrium posterior wall makes the thermosensitive esophagus a potential site of injury during catheter ablation of AF leading to various gastrointestinal complications. The major gastrointestinal complications associated with catheter ablation include atrioesophageal fistula, gastroparesis, esophageal thermal lesions and esophageal ulcers. Multiple studies, case reports and series have described these complications with various catheter ablation techniques such as radiofrequency, cryoenergy and high frequency focused ultrasound energy ablation. This review addresses the gastrointestinal complications after AF ablation procedures and aims to provide the clinicians with an overview of clinical presentation, etiology, pathogenesis, prevention and management of these conditions.