ArticleHeart rhythm O22020
Risk of atrioesophageal fistula with cryoballoon ablation of atrial fibrillation.
Article in Heart rhythm O2, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta-Analysis.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Pooled it
- Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Pooled it
- 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
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Journal of arrhythmia · 2024Article
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Innovations in atrial fibrillation ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023Review
- Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures.Journal of cardiovascular development and disease · 2023Review
- Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation.Frontiers in cardiovascular medicine · 2023Article
- Protecting Against Collateral Damage to Non-cardiac Structures During Endocardial Ablation for Persistent Atrial Fibrillation.Arrhythmia & electrophysiology review · 2022Review
- [Practical guide for safe and efficient cryoballoon ablation for atrial fibrillation : Practical procedure, tips and tricks].Herzschrittmachertherapie & Elektrophysiologie · 2021Review
- Preventing esophageal complications from atrial fibrillation ablation: A review.Heart rhythm O2 · 2021Article
- Left atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2021Article
- Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation.The Journal of innovations in cardiac rhythm management · 2021Article
- Routine measurement of oesophageal temperature during cryoballoon pulmonary vein isolation.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2021Article
- Cryoablation for atrial fibrillation: biophysics and a contemporary step-by-step approach.Indian pacing and electrophysiology journalReview
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough there are considerable data on the safety of cryoablation, data on the rare but severe complication of atrioesophageal fistula (AEF) following cryoballoon ablation are limited.
objectiveTo report the global, user-reported incidence of AEF associated with cryoballoon ablation for the treatment of atrial fibrillation using Medtronic's complaint database.
methodsUser-reported cryoballoon ablation complications occurring between July 1, 2009, and March 31, 2019, were reviewed to identify cases of AEF. A global event rate of AEF was calculated by dividing the event count by total catheter utilization over the same period. Data on symptoms and patient sequalae were reported as available.
resultsMore than 500,000 Arctic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, Arctic Front Advance ST, and Arctic Front Advance Pro; Medtronic, Inc) were distributed globally during the 9.75-year study period. During this time, 18 confirmed AEF, 1 suspected AEF, and 1 pericardial esophageal fistula were identified; therefore, global incidence of AEF associated with the Arctic Front family of ablation catheters was 0.00396%. Patients most commonly presented with fever (88.2%), and initial symptoms were reported a median of 21 (interquartile range: 4-30) days after the ablation. Although rare, the development of an AEF resulted in death in 68.8% (11/16) of patients with known outcomes.
conclusionsAEF is a possible but rare complication of cryoballoon ablation with a reported frequency of 1 in every 25,000 patients treated. Awareness of the prevalence and manifestation of AEF associated with cryoballoon ablation is critical for early identification and treatment of this complication.
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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 OpenQuestion graph.