Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation

Sánchez‐Quintana, Damián; Cabrera, José Ángel; Climent, Vicente; Farré, Jerónimo; Mendonça, Maria Cristina de; Ho, Siew Yen

doi:10.1161/circulationaha.105.551291

Cited by 284 publications

(252 citation statements)

References 28 publications

Supporting

Mentioning

217

Contrasting

Unclassified

Order By: Relevance

“…at a distance of 6.5 mm from the electrode-agar interface. This distance value coincides with the human anatomic distances previously reported [Ho et al 1999, Sanchez-Quintana et al 2005 . The another thermocouple was located at 2 mm from the first (i.e.…”

Section: Experimental Modelsupporting

confidence: 91%

See 1 more Smart Citation

A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

Lequerica¹,

Berjano²,

Herrero³

et al. 2008

Phys. Med. Biol.

View full text Add to dashboard Cite

Lequerica, JL.; Berjano, E.; Herrero, M.; Melecio, L.; Hornero, F. (2008). Cooled waterirrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: Experimental study based on an agar phantom. Physics in AbstractA great deal of current research is directed to finding a way to minimize thermal injury in the esophagus during radiofrequency (RF) catheter ablation of the atrium. A recent clinical study employing a cooling intraesophageal balloon reported a reduction of the temperature in the esophageal lumen. However, it could not be determined whether the deeper muscular layer of the esophagus was cooled enough to prevent injury. We built a model based on an agar phantom in order to experimentally study the thermal behavior of this balloon by measuring the temperature not only on the balloon, but also at a hypothetical point between the esophageal lumen and myocardium (2 mm distant).Controlled temperature (55ºC) ablations were conducted for 120 s. The results showed that: 1) The cooling balloon provides a reduction in the final temperature reached, both on the balloon surface and at a distance of 2 mm; 2) Coolant temperature has a significant effect on the temperature measured at 2 mm from the esophageal lumen (it has less effect on the temperature measured on the balloon surface); and 3) The precooling period has a significant effect on the temperature measured on the balloon surface (the effect on the temperature measured 2 mm away is small). The results were in good agreement with those obtained in a previous clinical study. The study suggests that that the cooling balloon gives thermal protection to the esophagus when a minimum pre-cooling period of 2 minutes is programmed at a coolant temperature of 5ºC or less.

show abstract

Section: Experimental Modelsupporting

confidence: 91%

“…This work was partially supported by the "Plan Nacional de Investigación Científica, reported [Ho et al 1999, Sanchez-Quintana et al 2005). The phantom was submerged in a saline bath maintained at 37ºC.…”

Section: Financial Supportmentioning

confidence: 99%

A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

Lequerica¹,

Berjano²,

Herrero³

et al. 2008

Phys. Med. Biol.

View full text Add to dashboard Cite

show abstract

“…Margins were kept to avoid misleading markers resulting from noise or density variation. At last, all pixels further than 6 mm away from the left atrium were also excluded, according to studies of the LA wall thickness on excised hearts [2,3].…”

Section: Marker-controlled Geodesic Active Contour (Mcgac)mentioning

confidence: 99%

“…This invasive procedure establishes transmural lesions to block the arrhythmia while avoiding impairing extra-cardiac tissues. Thereby the radio-frequency power dose, delivered for ablation during the procedure, relies on local myocardial thickness, which demonstrates variations by region and by subject [2,3]. Reduction of left atrial (LA) wall thickness also appears in AF patients when compared with controls, according to study by autopsy [4].…”

Section: Introductionmentioning

confidence: 99%

STACOM-SLAWT Challenge: Left Atrial Wall Segmentation and Thickness Measurement Using Region Growing and Marker-Controlled Geodesic Active Contour

Jia

Cadour

Cochet

et al. 2017

Statistical Atlases and Computational Models of the Heart. Imaging and Modelling Challenges

View full text Add to dashboard Cite

Abstract. Analyzing the structure of the left atrium can provide precious insights into the pathology of atrial fibrillation, eventually resulting in optimization of treatment plans. In this paper, an interactive and patient-specific method is presented to segment the left atrial endocardium 3 , the left atrial epicardium and measure the left atrial wall thickness from cardiac computed tomography images. A region growing algorithm was adapted to segment the left atrial endocardium, whereas the left atrial epicardium was segmented indirectly: a marker-controlled geodesic active contour model was defined on its surrounding environment. The results of the left atrial wall thickness were then mapped onto meshes generated from the endocardium segmentation. We tested our pipeline on 10 datasets as a part of the STACOM 2016 Left Atrial Wall Segmentation Challenge and we compared our method with manual segmentation. Aimed at facilitating the segmentation of the left atrial thin-wall structure, this pipeline is partially implemented in MUSIC software for clinical use. The expertise of clinicians can be added through the choice of specific parameters for each patient, although this remains optional owing to the robustness of the approach.

show abstract

“…Sanchez-Quintana et al, however, reported that the esophageal wall was a distance of over 5 mm from the endocardium of the LAPW in the analysis of their specimens. 19 They reported that there were wide variations in the distance because of differences in the thickness of the connective tissue and fibrofatty tissues intervening between the esophagus and LAPW. 19 In the current study, we demonstrated that the distance between the esophagus and LAPW was shorter at the middle and inferior portions of the LAPW than at the superior portion, where the mean distance was 6±6 mm, suggesting that an LA roof line could be safely created in most patients whereas care should be taken in order to avoid esophageal injury during RF energy application in the middle or inferior portions of the LAPW.…”

Section: Relationship Between the Esophagus And The Lapwmentioning

confidence: 99%

Real-Time 3-Dimensional Imaging of the Esophagus and Left Atrium With a Noncontact Mapping System

Miyamoto¹,

Tsuchiya²,

Ashikaga³

et al. 2009

Circ J

View full text Add to dashboard Cite

Background:Recognizing the relative location of the esophagus to the left atrial posterior wall (LAPW) is required to avoid esophageal injury during atrial fibrillation ablation. Methods and Results:The 24 patients undergoing circumferential pulmonary vein isolation (CPVI) each had the geometry of their left atrium (LA) and esophagus constructed by a noncontact mapping system with EnSite version 6.0J. The esophageal course relative to the LAPW was found to be to the left in 12, middle in 8, right in 2, and obliquely left-to-right in 2 patients, and in 13 patients (54%) it was located on or near either the left or right CPVI line. The mean distance between the esophagus and LAPW was shorter at the bottom line of the LAPW connecting both inferior pulmonary veins (3±3 mm) than at the LA roof line connecting both superior pulmonary veins (6±6 mm, P<0.01). Conclusions:The location of the esophagus relative to the LAPW varies with the patient, but a close location to either CPVI line was found in approximately 50% and a close location between the esophagus and LAPW was found in the inferior and middle locations in most patients.

show abstract

Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation

Cited by 284 publications

References 28 publications

A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

STACOM-SLAWT Challenge: Left Atrial Wall Segmentation and Thickness Measurement Using Region Growing and Marker-Controlled Geodesic Active Contour

Real-Time 3-Dimensional Imaging of the Esophagus and Left Atrium With a Noncontact Mapping System

Contact Info

Product

Resources

About