Comparison of computed tomography imaging with intraprocedural contrast esophagram: Implications for catheter ablation of atrial fibrillation

Daoud, Emile G.; Hummel, John D.; Houmsse, Mahmoud; Hart, David; Weiss, Raul; Liu, Zhenguo; Augostini, Ralph; Kalbfleisch, Steven J.; Smith, Macy C.; Mehta, Rohit; Gangasani, Ashish; Raman, Subha V.

doi:10.1016/j.hrthm.2008.03.058

Cited by 39 publications

(28 citation statements)

References 17 publications

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“…These findings are in agreement with previous studies using various imaging techniques [3][4][5][9][10][11][12]. Tsao et al [8] characterized esophageal location by proximity to the inferior PVs, finding a location closer to the LIPV (87%) was more prevalent than the RIPV (12%).…”

supporting

confidence: 92%

“…Individual studies by Kottkamp and Piorkowski [13,14] reported a 93 and 86% concordance of esophageal location, respectively, between pre-procedural CT and tagging with an esophageal catheter and Carto system during the procedure. Daoud et al [12] showed a different esophageal location in 13% of patients between CT and barium esophagram. However, even in patients with concordant location, 44% demonstrated differences in the esophageal borders of N50% of the esophageal diameter.…”

mentioning

confidence: 97%

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Real-time CartoSound imaging of the esophagus: A comparison to computed tomography

Wilson

Brooks

Lau

et al. 2012

International Journal of Cardiology

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supporting

confidence: 92%

mentioning

confidence: 97%

Real-time CartoSound imaging of the esophagus: A comparison to computed tomography

Wilson

Brooks

Lau

et al. 2012

International Journal of Cardiology

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“…In contrast to this, Good et al 23 demonstrated a significant mobility of the esophagus also in these segments, visualizing the esophagus by a barium swallow. A significant discord between CT-defined and esophagram-defined borders of the esophagus was also reported by Daoud et al 24 Luminal esophageal temperature monitoring during ablation at the posterior LA wall is used to guide the ablation procedure and possibly reduce esophageal injury. [25][26][27] All periesophageal and mediastinal lesions described here are directly related to the ablation procedure, given the regular index examination before ablation.…”

Section: Zellerhoff Et Al Esophageal and Mediastinal Changes After Pvimentioning

confidence: 79%

Damage to the Esophagus After Atrial Fibrillation Ablation

Zellerhoff¹,

Ullerich²,

Lenze³

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-Radiofrequency catheter ablation is increasingly used in the treatment of atrial fibrillation. Esophageal wall changes varying from erythema to ulcers have been described by endoscopy in up to 47% of patients following pulmonary vein isolation (PVI). Although esophageal changes are frequently reported, the development of a left atrial (LA)-esophageal fistula is fortunately rare. Nevertheless, mucosal changes may just represent "the tip of the iceberg." The aim of this study was, therefore, to investigate the more subtle changes of and injuries to the posterior wall of the LA, the periesophageal and mediastinal connective tissue, and the whole wall of the esophagus, including mucosal changes by esophagogastroduodenoscopy (EGD) combined with radial endosonography (EUS). Methods and Results-Twenty-nine patients (7 females; mean age, 57.7Ϯ10.5 years [range, 23-75 years]) underwent EGD and EUS before and after PVI within 48 hours. PVI was performed as a circumferential antral isolation of the septal and lateral pulmonary veins guided by a decapolar circular mapping catheter using a 3-dimensional mapping system with the integration of a preprocedurally acquired computed tomography scan of the left atrium. The maximum power applied was 30 W, with an open-irrigated catheter using a maximum flow rate of 30 mL/min. In all patients, the esophagus was reconstructed using the same computed tomography scan and displayed during the ablation procedure. In case of newly detected periesophageal changes, EGD and EUS were repeated 1 week after the PVI. In all patients, a regular contact area between the LA and the esophagus could be demonstrated before PVI. The mean vertical contact length was 4.4Ϯ1.5 cm (range, 2-10 cm); and the mean distance between the anterior wall of the esophagus and the endocardium was 2.6Ϯ0.8 mm (range, 1.4 -4.0 mm). After PVI, morphological changes of the periesophageal connective tissue and the posterior wall of the LA were diagnosed by endosonography in 8 patients (27%; 95% confidence interval, 12.73-47.24). No mucosal changes of the esophagus in terms of erythema or ulcers were found. In all but one patient (who refused the control), all periesophageal and atrial changes had resolved within 1 week. No atrioesophageal fistula occurred during follow-up (mean follow-up, 294Ϯ110 days [range, 36 -431 days]). Conclusions-Mucosal changes of the esophagus after PVI-like ulcers or erythema could not be demonstrated, yet structural changes of the mediastinum, which were only visible by endosonography, occurred in 27% of patients in the present study. This may indicate a higher than expected periesophageal injury because of PV ablation. Endosonography might prove to be a sensitive and reliable tool in the follow-up after PVI. (Circ Arrhythm Electrophysiol. 2010;3:155-159.)

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“…Monitoring of LET, periprocedural imaging with computed tomography, MRI or intracardiac echocardiography, modulation of power and duration of radiofrequency energy during ablation and mechanical esophageal displacement have been suggested as possible ways to decrease injury to the esophagus. [29][30][31][32][33][34][35][36][37] However, their roles in preventing VN injury during RFA have not been systematically studied. Further studies are therefore necessary to identify methods to safely perform AF ablation without damaging the VN.…”

Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated. Methods and Results-We performed a prospective, observational study assessing the effect of atrial fibrillation ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study, and sham-feeding test (corresponding to esophageal, gastric, and small intestinal function evaluation, respectively) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 new abnormality on the UGI function tests (P<0.001). New onset esophageal dysmotility, delayed gastric emptying time, and abnormal sham-feeding tests were observed in 13 (48%), 13 (48%), and 9 (33%) patients, respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (P=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions-Atrial fibrillation ablation results in functional impairment of the UGI system, including the esophagus, stomach, and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.

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Comparison of computed tomography imaging with intraprocedural contrast esophagram: Implications for catheter ablation of atrial fibrillation

Cited by 39 publications

References 17 publications

Real-time CartoSound imaging of the esophagus: A comparison to computed tomography

Real-time CartoSound imaging of the esophagus: A comparison to computed tomography

Damage to the Esophagus After Atrial Fibrillation Ablation

Effect of Atrial Fibrillation Ablation on Gastric Motility

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