Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .
Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation: Documented Higher Risk of Luminal Esophageal Damage With General Anesthesia as Compared With Conscious Sedation
Background —Left atrioesophageal fistula is a rare but devastating complication that may occur after  catheter ablation of atrial fibrillation . We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population r and omized to undergo general anesthesia or conscious sedation . Methods and Results —Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and r and omized , including those undergoing the procedure under general anesthesia ( 25 patients , group 1 ) and those receiving conscious sedation with fentanyl or midazolam ( 25 patients , group 2 ) . All patients underwent esophageal temperature monitoring during the procedure . The day after ablation , all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus . We observed esophageal tissue damage in 12 ( 48 % ) patients of group 1 and 1 esophageal tissue damage in a single patient ( 4 % ) of group 2 ( P<0.001 ) . The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia ( group 1 ) versus patients undergoing conscious sedation ( group 2 ) ( 40.6±1 ° C versus 39.6±0.8 ° C ; P < 0.003 ) . The time to peak temperature was 9±7 seconds in group 1 and 21±9 seconds in group 2 , and this difference was statistically significant ( P<0.001 ) . No complication occurred during or after the administration of the pill cam or during the procedures . All esophageal lesions normalized at the 2-month repeat endoscopic examination . Conclusion —The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy
Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .