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

Abstract

Esophageal injury is a potential serious complication of catheter ablation for atrial fibrillation (AF). We report a case of significant esophageal dilatation following previous laproscopic gastric banding (LGB) in a patient undergoing pulmonary vein isolation (PVI) for atrial fibrillation. Case ReportA 53 year male with a 2 year history of permanent atrial fibrillation and a prior history of laproscopic gastric banding (LGB) for obesity underwent a pre-procedure planning cardiac CT scan. Moderate esophageal dilatation was demonstrated on the cardiac CT with the esophageal diameter reaching a maximum of 42mm level with the posterior left atrial wall (Fig 1). A barium swallow showed normal esophageal motility but with markedly slowed emptying times (Fig 2).A catheter ablation procedure was performed which included wide pulmonary vein antral electrical isolation guided by a cardiac navigational system (Ensite, St Jude Medical) and intra-cardiac echocardiography (ICE).The position of the esophagus was delineated on the integrated CT navigational map and on fluoroscopy by placement of an esophageal thermistor probe. Radiofrequency energy was delivered through an open irrigated tip catheter and titrated to maximum 25W and 40°C for lesions applied to the left atrial posterior wall. Esophageal temperature rises were only seen in association with lesions applied to the right inferior pulmonary vein and energy applications here were limited to avoid esophageal temperatures >38.5°C.At 6 months follow-up the patient remains in sinus rhythm with no complications. DiscussionThe potential for esophageal injury following ab- AbstractEsophageal injury is a potential serious complication of catheter ablation for atrial fibrillation. We report a case of significant esophageal dilatation following previous laparascopic gastric banding in a patient with permanent atrial fibrillation undergoing a pulmonary vein isolation procedure.