2875Dabigatran-induced esophagitis after radiofrequency catheter ablation

Abstract

Background: Recently, there are some reports of dabigatran-induced esophagitis (DIE). Otherwise, there are some esophageal damage, such as atrioesophageal fistulae, esophageal erythema, esophageal ulcerations, and periesophageal nerve injury caused by an excessive damage beyond the left atrial (LA) posterior wall during radiofrequency catheter (RF) energy deliveries in the patients with atrial fibrillation (AF). However, the frequency and clinical characteristics of patients with DIE after RF ablation for atrial fibrillation (AF) have not yet been clarified. The aim of this study was to examine the prevalence and characteristics of DIE after RF ablation for AF. Method(s): The 77 patients who underwent RF ablation for AF with oral anticoagulant (warfarin=13, dabigatran=19, rivaroxaban=14, apixaban=29, edoxaban=2) were included in this study (average age: 65.4+/-9.7 years old, man/woman=57/20, paroxysmal/persistent=44/33). All patients underwent upper gastrointestinal endoscopy within 3days after ablation. The characteristic endoscopic findings of DIE showed longitudinally sloughing epithelial casts in the mid and/or lower esophagus. Result(s): Esophagitis was found in 5 of 19 patients with dabigatran (26.3%: DIEgroup), however it was not observed in patients with the other oral anticoagulants. The patients with esophageal symptom were more frequent in DIE-group (100%) than those without (14.3%: non-DIE-group, P<0.05). The rates of DIE were not associated with the dose of dabigatran (300mg: DIE-group/non-DIE-group= 40%/35.7%, P=1.0). Other factors including age, gender, other concomitant medications including proton pump inhibitor (DIE-group/non-DIE-group= 100%/85.7%, P=1.0) and RF energy on the posterior line did not differ between the two groups. Dabigatran was discontinued and changed to apixaban in three patients. The remaining two patients continued dabigatran with instructions, such as drinking sufficient water and maintaining an upright position for at least 30 min after ingestion of dabigatran. Clinical follow-up that included endoscopy was performed for 4 patients in DIE-group. Both the symptoms and endoscopic abnormalities disappeared in the one patients continued dabigatran and symptoms disappeared in another patients with continued dabigatran. Conclusion(s): Dabigatran causes the esophageal mucosal injury in approximately a quarter of patients after RF ablation for AF. It may require cautious use dabigatran in symptomatic patients for DIE.