Heads up to those undergoing cardiac ablation for Afib…had my ablation 12/6/23. Everything went great! Been in normal rhythm ever since! No bleeding, no hematoma, no real discomfort. However I woke up to abdominal pain, pain between shoulder blades and sore throat. 3 nights post op woke up to a burning throat and heart burn. Turns out when they ablate your cardiac tissue it is right next to your esophagus and burns it as well! A rare complication but one you should be aware of is an esophageal injury that becomes an ulcer and then a hole into your heart. To prevent this physicians send you home on a PPI like Protonix. I also requested carafate after being symptomatic to coat my esophagus and prevent an ulcer. I am on a bland diet for the next month to also protect my esophagus. No mention was ever made of this to me. So when you go home don’t eat a regular diet but avoid any acidic foods that may irritate your esophagus. Be sure to get a prescription for a PPI(anti acid) and look for signs like abdominal pain, painful swallowing, chest pain, fever, neurological signs like confusion. Seems to be most likely at around 3 weeks post op. But prevention is key as this is a rare but fatal complication of ablation no one talks about. Your esophagus is impacted by cardiac ablation!
Atrioesophageal fistula (AEF) - Atrial Fibrillati...
Atrioesophageal fistula (AEF)
Hi, I am sorry to hear you had a complication and I hope you make a full recovery with a successful ablation.
I have not needed an ablation yet (remaining optimistic) but I was aware of these events could occur. Catheter ablations tend to use thermal energy to treat Afib by either burning or freezing errant heart tissue This does carry a risk of damaging neighbouring tissue and structures, such as the oesophagus or the phrenic nerve.
I was reading recently, either on this forum or another website, about a new technique - pulse field ablation; basically uses non thermal energy, which does not have the same affect. I don’t think its widely available yet in the UK.
Best wishes
In the US, PPI's are often given both before, and after an ablation for reasons you mentioned.
Carafate was an excellent idea on your part. Just be very careful with the timing because it can inhibit the absorption of medications if both taken too close together.
Jim
Yes! Taking PPI first then waiting 30 min to take carafate then waiting 1 hr before eating a very bland diet
I'm not sure how much it matters with the PPI but the concern is taking carefate too close to a fib drugs, like beta blockers, calcium channel blockers, anti-arrythmias, etc, shld you be on them. It is good that you're taking the PPI one hour before a meal which is optimal for PPI efficacy.
Jim
Sorry to hear that nobody mentioned it or warned you,. Here in UK it is a well known but rare complication for some people and always part of the "sign this so you can't sue us " sheet. Most EPs here do discharge with PPIs these days.
All ablated patients on the ward with me last week were discharged with 6 weeks worth of Lansoprazole, 30mg x 42 and told to take them all regardless of symptoms.
Im so glad you ablation was a success and sorry to hear about the esophagus problem.
I’ve been waiting for my gut problems to clear up following ablation 11 weeks ago. I was not given PPIs by the cardio team and only got them prescribed by my GP a few weeks later. I took them for a couple of weeks but read they can prevent magnesium absorption and probably rather foolishly stopped them. I never had bad indigestion or reflux before the ablation and am thinking I should get back to my GP. I mainly notice it at night and take Gaviscon or Andrews - simple over the counter meds that do bring a bit of relief.
Thank you for your post, it has woken me up!
The chap in the next bed to me had heart burn symptoms straight after his ablation and had gaviscon and the ppi meds. I didn’t have heart burn so asked did I really need the PPI, yes, take them for 6 weeks even if no symptoms.
Yes, a lot of misinformation/advice about PPI's here and elsewhere. None of us like taking drugs but If you need them, you need them. If your heartburn is in the evening, you might be able to get away with an H2 blocker first.
Jim
“but read they can prevent magnesium absorption and probably rather foolishly stopped them”———————————————————————-
So many times I’m seeing “I read somewhere that…” but (sensible hat on) we really shouldn’t be making decisions based on what we read on the internet because whoever writes it has no responsibility whatsoever for our healthcare. It’s just like saying “someone at the bus stop told me that…” We wouldn’t ordinarily make decisions about out healthcare based on the words of random strangers we will never see again. But, I’ve also done the same, thought the same, been spooked into taking actions that are not in my best interests based on what I’ve read on the internet. And my health has suffered for it, mentally and physically
Several weeks of PPIs are not going to cause any long term side effects, and the consequences of one of these oesophageal fistulas are far worse. I’m not saying that there aren’t concerns about PPIs but it’s always a case of weighing up the risks versus benefits for the individual. Someone popping PPIs for a bit of acid reflux is entirely different from someone recovering from a cardiac procedure. Are those internet articles giving personalised advice to someone recovering from a cardiac operation? No? Then disregard it and maybe put your feet up with a copy of whatever uplifts your spirits. 
Thank you Autumn Leaves. Point taken. It was actually on the forum that I read about it, but same thing. You’ll be pleased to know I’m back on the Lansoprazole and have ordered a repeat prescription!
The important thing is that you make a good recovery from your ablation and hopefully you’ll remain AF free. It seems to be working out very well so far. I’m not pro or anti anything, it’s about what’s appropriate for the individual. You can always come off the PPI later on when everything is healed. It’s not necessarily forever. In these days of being an active participant in one’s healthcare, it’s not easy to evaluate all the info coming at us right and left. I don’t know about you but I find it really hard work!
OMG this is terrifying. But thank you for the warning
I've been on Lansoprazole daily for years. Wonder how this affects the scenario. I'm on the waiting list, so will be finding out sometime. Don't recall seeing anything about this issue on usual literature.
Sorry to hear of this unwelcome complication. I've just had a Pulse-Field ablation (yesterday!) and although the risk of oesophageal damage is much lower with PFA, I've been prescribed PPI for 4 weeks as a precaution. The EP says the likelihood is so remote but prefers to preempt rather than having to treat. Thank you for the warning though - everyone should be reminded.
That's really odd they didn't mention it or give you PPIs to go home with you, unless you're not in the UK?I was told about it at my discussion with EP, before I signed the consent forms and on the pre and post op info sheets. I was also given a 6 week supply of Omeprazole before I left the hospital.
Hope all heals up well and you feel better soon.
Thanks, I think it very appropriate that these so called rare occurrences are flagged up and is why ablation will only be for me when I run out of options.
I was given a small credit card sized info card to carry with symptoms to look out for AND to show at A&E if I did get symptoms. This was after my third in 2022 but not after the previous two in 2020 and 2021, so obviously a new thing at Papworth.
I was made fully aware of the tiny percentage of ablations which affect the esophagus before my ablation - in fact one of my questions at the initial discussion with my EP was how he goes about minimising the chances of that. He gave reassurance and that was that. I wasn't given any antacid medication and wouldn't have needed it anyway.
I was aware of this before the ablation, and must admit it was one of the things that really worried me. I didn’t get PPIs. I did mention that this was one of my worries when the EP spoke to me before discharge, and he said it wasn’t a worry in my case. I wonder if our anatomy and/or areas to be ablated can differ slightly so that the oesophagus isn’t as close? Of course I still worried at every twinge!
I hope that you continue to recover well, and that your heart rhythm behaves too!
Yes the location of my ablation as well as my size is the reason for my esophageal injury. I am a small female. Less than 120lbs
Ablation is a road down which I hope not to travel.
I knew about this but wasn't offered PPIs since my stomach doesn’t produce acid anyway. I did cough a bit after the first ablation but took Gaviscon, which is what I normally use. I was more impacted in one side of the diaphragm for a few days - felt like I could only take I'm half a breath- very weird. I suppose they disturbed the left phrenic nerve. Hope you're soon recovered.
I had read about the possibility of this rare complication which, according to the literature, often leads to death in many cases. I had my second ablation on Dec. 5. My EP places a cooling catheter into the esophagus (along with two others) to monitor and keep the temperature low during the procedure. I’ve been on a PPI (pantoprazole) 40mg x 2 daily for years anyway so no one mentioned this before or after my procedure. My question here is: Doesn’t the EP know at the time of the ablation whether or not this occurred or, does it have to be obvious, severe, and observable then? The person here whose EP told him he doesn’t need PPI’s, etc. sounded pretty confident. But if this complication might not show up for three weeks post-procedure, how can the EP really “know” it didn’t happen?
My EP was surprised based on my temperature readings in esophagus. If I had known of this complication I probably would not have had an ablation
I’m sorry that this happened but it sounds like, in the range of severity of this complication, yours wasn’t the worst (of course, weak consolation for what you ARE suffering. I hope it heals and you recover completely.
Thank you! Thankful no stroke
Wishing you a full recovery and that your ablation is successful
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