Initial Experience of Assessing Esophageal Tissue Injury and Recovery Using Delayed-Enhancement MRI After Atrial Fibrillation Ablation

Badger, Troy J.; Adjei-Poku, Yaw A.; Burgon, Nathan; Kalvaitis, Saul; Shaaban, Akram M.; Sommers, Daniel; Blauer, Joshua; Fish, Eric N.; Akoum, Nazem; Haslem, Thomas S.; Kholmovski, Eugene; MacLeod, Rob S.; Adler, Douglas G.; Marrouche, Nassir F.

doi:10.1161/circep.109.871939

Cited by 41 publications

(23 citation statements)

References 16 publications

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“…Of these patients, 3/5 underwent upper endoscopy that revealed mucosal lesions in the esophagus that corresponded to the anatomic location of inflammation seen on MRI. These patients also underwent endoscopic ultrasound that demonstrated the preservation of esophageal wall architecture, despite the mucosal lesions identified, also arguing against significant esophageal injury, despite an endoscopic finding [11]. This suggests that delayed MRI following AFA, rather than immediate MRI, may be a better tool to detect meaningful esophageal injury.…”

Section: Discussionmentioning

confidence: 95%

Cross-Sectional Imaging Obtained Immediately Following Radiofrequency Atrial Fibrillation Ablation Does Not Predict Endoscopic Evidence of Esophageal Injury

et al. 2011

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There was no agreement between immediate imaging and the endoscopic findings of esophageal inflammation after AFA. A longer period of time between AFA and obtaining an imaging study may be useful in detecting patients with significant esophageal injury who should undergo EGD to assess for complications of AFA. Further studies are needed in order to determine the best modalities and optimal timing to detect post-AFA esophageal damage in an attempt to prevent the formation of atrial-esophageal fistulas.

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Section: Discussionmentioning

confidence: 95%

Cross-Sectional Imaging Obtained Immediately Following Radiofrequency Atrial Fibrillation Ablation Does Not Predict Endoscopic Evidence of Esophageal Injury

et al. 2011

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“…Third, only the presence of esophageal mucosal injury was assessed. Injury to adjacent structures, which may be detected with more sophisticated imaging modalities such as MRI 13 or esophageal endosonography, 14 may be underestimated. We believe that the presence of esophageal mucosal injury is critical to report as this is the presumed precursor to the development of the LA-esophageal fistula.…”

Section: Limitationsmentioning

confidence: 99%

Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures

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Santos

Maia

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Methods and Results-Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation Ͼ2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5Ϯ1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. Conclusions-A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures. (Circ Arrhythm Electrophysiol. 2011;4:149-156.)

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“…We sought to replicate prior studies of the correlation between acute LGE and acute T2W imaging [16], and between acute and late LGE imaging [30]. Further we sought to add to the existing knowledge of the relationship of acute T2w to 30-day LGE.…”

Section: Introductionmentioning

confidence: 98%

Cardiovascular Magnetic Resonance Imaging of Scar Development Following Pulmonary Vein Isolation: A Prospective Study

et al. 2014

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AimsCardiovascular magnetic resonance (MR) provides non-invasive assessment of early (24-hour) edema and injury following pulmonary vein isolation (by ablation) and subsequent scar formation. We hypothesize that 24-hours after ablation, cardiovascular MR would demonstrate a pattern of edema and injury due to ablation and the severity would correlate with subsequent scar.MethodsFifteen atrial fibrillation patients underwent cardiovascular MR prior to pulmonary vein isolation, 24-hours post (N = 11) and 30-days post (N = 7) ablation, with T2-weighted (T2W) and late gadolinium enhancement (LGE) imaging. Left atrial wall thickness, edema enhancement ratio and LGE enhancement were assessed at each time point. Volumes of LGE and edema enhancement were measured, and the circumferential presence of injury was assessed at 24-hours, including comparison with LGE enhancement at 30 days.ResultsLeft atrial wall thickness was increased 24-hours post-ablation (10.7±4.1 mm vs. 7.0±1.8 mm pre-PVI, p<0.05). T2W enhancement at 24-hours showed increased edema enhancement ratio (1.5±0.4 for post-ablation, vs. 0.9±0.2 pre-ablation, p<0.001). Edema and LGE volumes at 24-hours were correlated with 30-day LGE volume (R = 0.76, p = 0.04, and R = 0.74, p = 0.09, respectively). Using a 16 segment model for assessment, 24-hour T2W had sensitivity, specificity, and accuracy of 82%, 63%, and 79% respectively, for predicting 30-day LGE. 24-hour LGE had sensitivity, specificity, and accuracy of 91%, 47%, and 84%.ConclusionsIncreased left atrial wall thickening and edema were characterized on cardiovascular MR early post-ablation, and found to correlate with 30-day LGE scar.

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Initial Experience of Assessing Esophageal Tissue Injury and Recovery Using Delayed-Enhancement MRI After Atrial Fibrillation Ablation

Cited by 41 publications

References 16 publications

Cross-Sectional Imaging Obtained Immediately Following Radiofrequency Atrial Fibrillation Ablation Does Not Predict Endoscopic Evidence of Esophageal Injury

Cross-Sectional Imaging Obtained Immediately Following Radiofrequency Atrial Fibrillation Ablation Does Not Predict Endoscopic Evidence of Esophageal Injury

Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures

Cardiovascular Magnetic Resonance Imaging of Scar Development Following Pulmonary Vein Isolation: A Prospective Study

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