ReviewPacing and clinical electrophysiology : PACE2025
Minimizing Atrioesophageal Fistula Risk After AF Ablation: Risk Factors, Prevention, and Emerging Mini-Thermal Technology.
Review in Pacing and clinical electrophysiology : PACE, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Atrioesophageal fistula after atrial fibrillation ablation: a single-center experience with multicenter comparisons.BMC surgery · 2025Article
- Minimizing Atrioesophageal Fistula Risk After AF Ablation: Risk Factors, Prevention, and Emerging Mini-Thermal Technology.Pacing and clinical electrophysiology : PACE · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Atrial esophageal fistula (AEF) is a rare but life-threatening complication of atrial fibrillation (AF) ablation, linked to thermal injuries by conventional radiofrequency (RF) and cryo-balloon (CB) ablation techniques. AEF risk can be mitigated by considering several measures such as tailored power settings of ablation technique, mechanical displacement of esophagus, esophageal cooling, and alternative ablative techniques and energy sources. We review the current knowledge regarding AEF and esophageal thermal injuries as well as discussing the current research regarding a novel none-to-minimally thermal, myocardial tissue-selective modality known as pulsed-field ablation (PFA) which may mitigate such risks. By inducing irreversible electroporation, PFA reduces thermal injury and demonstrates improved safety profiles, as evidenced by recent meta-analyses reporting zero esophageal injury and AEF cases. Additionally, the integration of 3D mapping systems with PFA has enhanced its procedural precision and accuracy while lowering the radiation exposure. Despite these advances, challenges such as standardizing anesthesia protocols and tailoring energy settings remain. Our review suggests that PFA may reduce the risk of AEF from catheter ablation of AF. While early outcomes of PFA are encouraging, it is important to recognize that preliminary data may not always be predictive of long-term AEF formation risk, as demonstrated by earlier experiences with CB ablation. Although PFA may reduce the risk of any aberrant thermal injuries, recent studies report significant increase in collateral damage including hemolysis, exaggerated troponin leak and coronary vasospasms. PFA should be used with caution in patients with hemolytic anemia or renal dysfunction, as they may experience more pronounced effects. Future long-term outcome studies should provide more information on possible adverse outcomes with PFA as well as tailoring the power settings of PFA.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.