Avoiding oesophageal injury during cardiac ablation: insights gained from mediastinal anatomy

Marar, Devan; Muthusamy, Venkatraman; Krishnan, Subramaniam

doi:10.1093/europace/eux024

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…The mobility of the esophagus has been well described in previous studies, including an autopsy study which reported that the esophagus can move laterally between 2.7–5.5 cm by using the stylet probe extending to the gastro-esophageal (GE) junction[13]. Other studies have tried using this mobility to move the esophagus during ablation by moving the esophagus with a catheter or echo probe[14, 15].…”

Section: Discussionmentioning

confidence: 99%

Distance between the left atrium and the vertebral body is predictive of esophageal movement in serial MR imaging

Yamashita

Quang

Schroeder

et al. 2018

J Interv Card Electrophysiol

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PURPOSE MRI or CT imaging can be used to identify the esophageal location prior to left atrial ablation but the esophagus may move making the location unreliable when ablating to minimize esophageal injury. The aim of this study was to evaluate esophageal position and movement based on serial MRI imaging with the goal of identifying imaging and clinical characteristics that can predict the esophageal movement. METHODS Fifty patients undergoing 190 MRI scans were analyzed. The relative position of the esophagus in each MRI along with clinical and imaging characteristics were quantified, including the gap between the LA and the vertebral body (GAP), an anatomic space in which the esophagus can move. RESULTS A mean of 3.8 MRIs were analyzed per patient. Sixteen patients (32.0%) experienced significant lateral esophageal movement of more than 10 mm. In the significant movement group, body mass index (BMI) was higher (33.0 ± 6.5 vs 28.8 ± 5.3, p=0.02) and the GAP was significantly larger (7.1 ± 2.5 vs 4.8 ± 5.1 mm, p=0.04). Multivariate logistic regression analysis revealed that the GAP ≤ 4.5 mm was the only independent predictor of the esophagus not moving (Odds Ratio=9.25, 95% confidence interval=1.72 to 49.67, p=0.0095). CONCLUSION A GAP of less than 4.5 mm between the LA and the vertebral body is associated with lack of esophageal movement (< 10 mm). This suggests that the measurement of GAP < 4.5 mm may be used to predict the esophageal location in patients undergoing atrial ablation.

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Section: Discussionmentioning

confidence: 99%

Distance between the left atrium and the vertebral body is predictive of esophageal movement in serial MR imaging

Yamashita

Quang

Schroeder

et al. 2018

J Interv Card Electrophysiol

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“…Intrathoracic esophagus and pericardium are located in the posterior and middle mediastinum, respectively, and the esophagus is attached to the parietal pericardium. 4 If the esophageal content contaminates the mediastinum due to esophageal tear, it causes inflammatory reaction and infection in the mediastinum and pericardium. Mediastinal infection and abscess can lead to serious clinical conditions such as sepsis and multiorgan failure which can cause death, if not treated immediately.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment Of A Late Diagnosed Esophageal Perforation With Mediastinitis And Pericardial Abscess

Küpeli

Doğan

2018

J Coll Physicians Surg Pak

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We herein report a case of late diagnosed thoracic esophageal perforation. A 60-year-old man was diagnosed as an esophageal perforation with mediastinitis and pericardial abscess by detailed history taking, chest computed tomography, esophagoscopy and inflammatory findings in his blood test. Surgical drainage of mediastinum and pericardium was able to effectively control infectious process and pericardial fibrosis. Endoscopic esophageal stent placement on the thoracicesophageal fistula promoted healing of the esophageal wall defect and enabled him to restart oral intake. This case report suggests that detailed history taking is important for all patients. Effective drainage of mediastinum and the use of esophageal stent may be the treatment options for late-diagnosed esophageal perforation.

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“…The clinical success of radiofrequency ablation (RFA) for atrial fibrillation depends on achieving a transmural lesion, that is, a lesion that occupies the entire thickness of the atrial wall . Since this can be as little as 2 mm , and may be close to the esophagus , it is thus crucial to ensure a specific lesion depth. Different technologies have attempted to evaluate lesion size , but the correlation of their parameters with lesion size was seen to be low.…”

Section: Introductionmentioning

confidence: 99%

Relation between denaturation time measured by optical coherence reflectometry and thermal lesion depth during radiofrequency cardiac ablation: Feasibility numerical study

González-Suárez¹,

Herranz²,

Berjano

et al. 2017

Lasers Surg Med

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Avoiding oesophageal injury during cardiac ablation: insights gained from mediastinal anatomy

Cited by 6 publications

References 21 publications

Distance between the left atrium and the vertebral body is predictive of esophageal movement in serial MR imaging

Distance between the left atrium and the vertebral body is predictive of esophageal movement in serial MR imaging

Successful Treatment Of A Late Diagnosed Esophageal Perforation With Mediastinitis And Pericardial Abscess

Relation between denaturation time measured by optical coherence reflectometry and thermal lesion depth during radiofrequency cardiac ablation: Feasibility numerical study

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