0019: Significance of atrial fibrillation/tachycardia induced by esophageal stimulation

Esophageal electrophysiological study (EPS) is an easy means to evaluate the cause of palpitations in patients with negative Holter monitoring or when cardiac event monitor is not interpretable. The purpose of study was to evaluate the clinical significance and the diagnosis value of inducible atrial tachycardia or fibrillation (AF) by esophageal EPS. Methods Esophageal EPS was performed in 159 patients, 72 males, 87 females, aged from 19 to 89 years (mean 56±16) with a normal ECG in sinus rhythm; 35 patients had presented one episode of documented sustained AF (group I). Remaining 124 patients had no documented AF (group II) and were studied for not documented tachycardia (n=70), not documented tachycardia associated with dizziness/syncope (n=23), unexplained stroke and salvos of AF (n=25), wide-QRS tachycardia suspected of atrial origin (n=6). Atrial pacing and programmed atrial stimulation with 1 and 2 extrastimuli were performed in control state (CS) and after infusion of isoproterenol. Patients were followed from 1 month to 13 years (mean 4±4 years). Results Among group I, AF was induced in 21 patients (60%). Sustained AF was induced in CS (n=50) or after isoproterenol (n= 64) in all group II patients. The follow-up indicated that 7 group I patients (21%) had recurrent AF/atrial flutter requiring ablation, 5 patients with induced AF and 2 with negative EPS (NS). Two group I patients (6%) with induced AF died from a cardiac cause. Among group II, 20 patients (16%) presented documented AF/atrial flutter and 14 of them required an ablation. Five group II patients (4%) died from a cardiac cause. The sensitivity of esophageal EPS to reproduce AF was 60%. Its positive predictive value to predict the occurrence of AF in symptomatic patients without documented AF was 16%. The positive value to predict AF and cardiac death was 24%. Conclusions Despite an average sensitivity for the induction of AF in patients with documented AF, the risk of subsequent AF and/or cardiac death was relatively high in these patients and in symptomatic patients without documented AF but with induced AF. These patients require a careful follow-up.