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Prevalence of Fever in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation Guided by Barium Esophagraphy


  • Dr. R.S. Ruby and Dr. D. Wells contributed equally to this manuscript.

  • Dr. Pelosi reports receiving research grants and compensation for participation on a speaker's bureau from Boston Scientific and Medtronic. Dr. Oral reports ownership or partnership interest, stock options and/or other rights in a patent or intellectual property for Ablation Frontiers, Inc. The other authors report no conflicts.

Address for correspondence: Aman Chugh, M.D., Cardiovascular Center, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA. Fax: 734-936-7026; E-mail:


Background: Real-time esophageal imaging is critical in avoiding esophageal injury. However, the safety of esophageal imaging with barium has not been specifically explored.

Methods: Three hundred seventy consecutive patients underwent left atrial (LA) ablation of atrial fibrillation (AF) under conscious sedation. One hundred eighty-five patients (50%) underwent the ablation procedure with, and 185 patients (50%) underwent the procedure without administration of barium. Fever, as a surrogate for aspiration, was defined as a maximal temperature ≥100°F within the first 24 hours following the ablation procedure.

Results: Thirty of the 370 patients (8%) developed fever within 24 hours after LA ablation. The prevalence of fever was 9% (17/185) among patients who received barium and 7% (13/185) among those who did not receive barium (P = 0.6). Evaluation revealed the following causes of fever in 14 of the 30 patients (47%) with no difference in prevalence between the 2 groups: pericarditis, venous thromboembolism, hematoma, and infiltrate on chest radiography. Multivariate analysis failed to reveal any factors associated with development of fever. None of the patients experienced serious complications such as respiratory failure or atrioesophageal fistula.

Conclusions: Fever may occur in approximately 10% of patients undergoing LA ablation of AF. Administration of barium is not associated with fever or other complications such as aspiration pneumonia. Real-time imaging of the esophagus with barium administration in conjunction with conscious sedation appears to be safe.