Assessment of Temperature, Proximity, and Course of the Esophagus During Radiofrequency Ablation Within the Left Atrium

Abstract

Background-Left atrioesophageal fistula is a devastating complication of atrial fibrillation ablation. There is no standard approach for avoiding this complication, which is caused by thermal injury during ablation. The objectives of this study were to evaluate the course of the esophagus and the temperature within the esophagus during pulmonary vein antrum isolation (PVAI) and correlate these data with esophagus tissue damage. Methods and Results-Eight-one patients presenting for PVAI underwent esophagus evaluation that included temperature probe placement. Esophagus course was obtained with computed tomography, 3D imaging (NAVX), or intracardiac echocardiography. For each lesion, the power, catheter and esophagus temperature, location, and presence of microbubbles were recorded. Lesion location and esophagus course were defined with 6 predetermined left atrial anatomic segments. Endoscopy evaluated tissue changes during and after PVAI. Of 81 patients, the esophagus coursed near the right pulmonary veins in 23 (28.4%), left pulmonary veins in 31 (38.3%), and mid-posterior wall in 27 (33%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…253,436,507,508,622,623, 624,625,630,870,871,995,996,997,998,999,1000,1001,1002 Most of these tachycardias originate in the LA, although RA cavotricuspid isthmus (CTI)-dependent flutters might also occur. Patients with a regular AT of new onset might complain of worsening symptoms due to a faster mean ventricular rate (frequently 2:1 ventricular response) than that during AF preablation.…”

New aspects of ablation treatment for atrial fibrillation

“…There are 3 major issues possibly explaining differences among reports, namely catheters used, maximum energy settings, and energy titration methods. Data on catheter dependence of EU are confusing (28,62,63,64 (65). In our study, we again demonstrate a low incidence of EU using an OIC technique, confirming previous results of a randomized prospective trial.…”

“…In our study, we again demonstrate a low incidence of EU using an OIC technique, confirming previous results of a randomized prospective trial. Temperature probes were used to monitor energy delivery and temperature increase in the esophagus in other studies (28,31,58,63,65). As stated in these studies, luminal esophageal temperature (LET) monitoring has major limitations, such as malalignment of the probe to the RFA catheter and posterior LA wall, the underestimation of intramural temperature by an intraluminal probe, and the too-slow LET increase to prevent EU.…”

Esophageal Dilatation Post - Gastric Banding and Catheter Ablation for Atrial Fibrillation: A Case Report

“…9 Reliance on the anatomical relationships from a preprocedural CT scan is recognized as being less accurate as the range of esophageal motion during a catheter ablation for AF has been shown to be greater than 2cm. 10 It is currently unclear what the impact of oesophageal pathology is on "added" vulnerability to injury from cardiac radiofrequency energy application.…”