Introduction: Thermal esophageal injury is a rare but relevant side effects of atrial fibrillation catheter ablation. Therefore routine post ablation endoscopy has recently been included into post-ablation follow-up after catheter ablation at some EP centers. Aim of this analysis was to evaluate the incidence of all clinically relevant endoscopical findings (ablation induced as well as all incidental gastrointestinal findings).

Methods and Results: Consecutive patients undergoing left atrial catheter ablation including pulmonary vein isolation using an open-irrigated ablation catheter in conjunction with a 3D electroanatomical mapping system were included in this analysis. In all patients post-ablation endoscopy was performed.

79 consecutive patients (68±10 years; 47% male; 52% paroxysmal AF; 81% first-time AF ablation) were included. 9 patients (11%) demonstrated endoscopic detected esophageal lesions (all type 1 lesions, i.e. erosion, erythema or ulcer < 5mm) and 6 patients (8%) ablation-induced gastroparesis, whereas 39 patients (49%) demonstrated incidental gastrointestinal findings not associated with the procedure. In 7 patients with ablation-associated findings a follow-up endoscopy was done. With regard to ongoing oral anticoagulation the most clinically relevant incidental findings were: erosive reflux esophagitis (5%) and erosive gastritis or duodenitis (10%). Additionally, in 13 patients (16%) further diagnostic or therapeutic procedures were required due to the initial endoscopy finding of: esophageal adenocarcinoma (1 %), adenoma of the papilla duodeni major (1 %), Barrett´s esophagus (9%) and esophageal or gastric polypoid neoplasia of primarily unknown dignity (5 %).

Conclusion: Routine esophagogastroduodenoscopy after atrial fibrillation catheter ablation should be included into post-ablation follow-up if post procedural esophageal endoscopy is performed. Endoscopy revealed clinically relevant findings in 41% - i.e. ablation-induced esophageal injury (11% EDEL, 8% gastroparesis); further relevant findings in 20 of 79 patients, partially with the need for further diagnostic and/or therapeutic interventions.