Movement of the Esophagus During Left Atrial Catheter Ablation for Atrial Fibrillation

Good, Eric; Oral, Hakan; Lemola, Kristina; Han, Jihn; Tamirisa, Kamala; Igic, Petar; Elmouchi, Darryl; Tschopp, David; Reich, Scott; Chugh, Aman; Bogun, Frank; Pelosi, Frank; Morady, Fred

doi:10.1016/j.jacc.2005.08.042

Cited by 193 publications

(117 citation statements)

References 8 publications

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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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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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“…The location of the esophagus can be visualized using a variety of approaches, including multidetector CT, topographic tagging of the esophageal position with an EAM system, barium paste, and ICE. 869,870,871,872,873,874,875,876 It is important to know that esophagus location can change during the procedure, and repeated imaging or visualization is needed to account for the motion of the esophagus. However, it is difficult to accomplish complete PV ablation without some ablation in close proximity to the esophagus.…”

Section: Section 7: Technical Aspects Of Ablation To Maximize Safety mentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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“…7 Intraprocedural monitoring of the course of the esophagus in relation to the left atrium has also been suggested and includes continuous ICE monitoring of esophagus location, 8 intraprocedural barium swallow and placement of an oesophageal thermistor. 9 Reliance on the anatomical relationships from a preprocedural CT scan is recognized as being less accurate as the range of esophageal motion during a catheter ablation for AF has been shown to be greater than 2cm. 10 It is currently unclear what the impact of oesophageal pathology is on "added" vulnerability to injury from cardiac radiofrequency energy application.…”

Section: Discussionmentioning

confidence: 99%

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

Phillips¹,

Townsend²,

James³

et al. 2009

J.A.F.I.B

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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.

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Movement of the Esophagus During Left Atrial Catheter Ablation for Atrial Fibrillation

Cited by 193 publications

References 8 publications

Effect of Atrial Fibrillation Ablation on Gastric Motility

Effect of Atrial Fibrillation Ablation on Gastric Motility

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

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

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