Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation

Abstract

The position of the esophagus to the LA is highly variable. The most common position of the esophagus relative to the LA is behind the middle and left part of the posterior wall of the LA. The least frequently observed position is behind the right pulmonary veins. No significant position change of esophagus motion from before to after the ablation procedure in the majority (≥95%) of the patients was observed.

Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

“…Another study found that esophageal position was relatively stable before and after ablation using 3D rotational angiography for the PVs and visualization of the esophagus via peroral administration of a contrast agent. 14 However, whether esophageal movement is stimulated by the swallowing of barium and whether general anesthesia has any influence on esophageal motility with a postulated hypothesis that the esophagus has a resting position are unknown. Real-time observation of the esophageal position is feasible with intracardiac echocardiography, but this costly option is not widely available.…”

“…Sherzer et al, found a stability of the esophageal position relative to the spine by means of an ablation catheter in the esophagus during the whole procedure in patients under general anesthesia 13 . Another study found that the esophageal position was relatively stable before and after ablation using 3D rotational angiography for the PVs and visualization of the esophagus via peroral administration of a contrast agent 14 . Yet, it is unknown if the esophageal movement is stimulated by the swallowing of barium and whether general anesthesia has any influence on esophageal motility with a postulated hypothesis that the esophagus has a resting position.…”

Esophageal luminal temperature rise during atrial fibrillation ablation is associated with lower radiofrequency electrode distance and baseline impedance

“…The importance here, is that images acquired up to 30 days before the procedure, provide important and relevant anatomical information regarding esophageal location relative to the left atrium and pulmonary vein antra. Although data regarding esophageal stability overtime are conflicting, 17–19 it is likely that any esophageal movement in the posterior left atrium region is minimal, related to peristalsis, and unlikely to constrain the utility of preacquired images. A prior study by Sarairah et al 20 found that endoscopically detected esophageal thermal lesions were negatively associated with the shortest distance between the esophageal lumen and the atrial endocardium.…”

Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation

“…Metoda je výrazně účinnější než farmakologické strategie a stala se metodou první volby v léčbě této arytmie (13)(14)(15). Postupně byla zapojena celá řada metod zvyšujících účinnost a bezpečnost RFA (16)(17)(18)(19)(20)(21). KA byla následně doplněna dalšími technologiemi jako například kryoablace (22) či laserové ablace (23), které jsou obdobně jako RFA založené na termálním faktoru v tvorbě ablačních lézí.…”