Novel Imaging Techniques of the Esophagus Enhancing Safety of Left Atrial Ablation

Pollak, Scott J.; Monir, George; Chernoby, Michael S.; Elenberger, C D

doi:10.1046/j.1540-8167.2005.40560.x

Cited by 43 publications

(38 citation statements)

References 10 publications

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“…Alternative strategies described to avoid esophageal injury during AF ablation have included visualization of the esophagus with an enteral feeding tube, barium paste, or electroanatomic mapping, 19,20 cooling of the esophagus to counter RF ablation-associated increases in esophageal temperature, 21 and using cryoablation rather than RF energy. 22 However, the effectiveness of these approaches on minimizing esophageal injury has not been thoroughly studied.…”

Section: Alternative Esophageal Protective Strategiesmentioning

confidence: 99%

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Singh

d’Ávila²,

Doshi³

et al. 2008

Circulation: Arrhythmia and Electrophysiology

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Section: Alternative Esophageal Protective Strategiesmentioning

confidence: 99%

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Singh

d’Ávila²,

Doshi³

et al. 2008

Circulation: Arrhythmia and Electrophysiology

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“…10,15,17 For the interventionist, imaging that can allow the esophagus to be seen in real time with adequate resolution of wall thickness will help considerably. 23,24 …”

Section: Discussionmentioning

confidence: 99%

Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation

et al. 2005

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Background-Esophageal injury is a potential complication after intraoperative or percutaneous transcatheter ablation of the posterior aspect of the left atrium. Understanding the spatial relations between the esophagus and the left atrium is essential to reduce risks. Methods and Results-We examined by gross dissection the course of the esophagus in 15 cadavers. We measured the minimal distance of the esophageal wall to the endocardium of the left atrium with histological studies in 12 specimens.To measure the transmural thickness of the atrial wall, we sectioned another 30 human heart specimens in the sagittal plane at 3 different regions of the left atrium. The esophagus follows a variable course along the posterior aspect of the left atrium; its wall was Ͻ5 mm from the endocardium in 40% of specimens. The posterior left atrial wall has a variable thickness, being thickest adjacent to the coronary sinus and thinnest more superiorly. Behind is a layer of fibrous pericardium and fibrofatty tissue of irregular thickness that contains esophageal arteries of 0.4Ϯ0.2-mm external diameters. Conclusions-The

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“…Understanding the anatomical relationship between the esophagus and LA can be performed by CT angiography after a barium swallow, 48,49 magnetic resonance contrast angiography using swallowed barium sulfate paste and gadolinium diglutamate, 48 or electroanatomical mapping using CARTO™ 48 or NavX™ . 50 Reducing the RF power when ablating the LA posterior wall, monitoring the esophageal temperature, moving the LA posterior line to the roof, and esophageal cooling with a cooled water-irrigated intraesophageal balloon 51 might reduce that risk.…”

Section: Atrio-esophageal Fistulamentioning

confidence: 99%

Complications in the Catheter Ablation of Atrial Fibrillation

Takahashi

Kuwahara

Takahashi

2009

Circ J

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Circ J 2009; 73: 221 -226 ince the discovery of the main role of pulmonary vein (PV) foci in the initiation of atrial fibrillation (AF), 1 radiofrequency (RF) catheter ablation, basically targeting the PVs, has been developed as an effective treatment for recurrent, drug-resistant AF. [2][3][4] Moreover, various types of ablation strategies, such as extensive circumferential PV isolation including the atrial tissue in the adjacent left atrium (LA), 5-12 linear ablation [13][14][15][16] and complex fractionated electrogram-guided ablation, [17][18][19][20][21] have been used to achieve a high efficacy for all types of AF. However, these extensive and complex ablation strategies are associated with a relatively higher incidence of complications, 22,23 compared with ablation of other arrhythmias. Moreover, devastating complications, such as atrio-esophageal fistulas, have been reported, 24,25 caused by extracardiac penetration of the ablative energy, which is 1 of the unsolved safety issues concerning AF ablation. Incidence of ComplicationsComplications of AF ablation include vascular access accidents, cardiac perforation/tamponade, thromboembolic events, PV stenosis, extracardiac injury such as to the esophagus, nerve damage, and atypical atrial flutter. In a worldwide survey of 8,745 patients who underwent AF ablation reported by Cappato et al, 22 major complications occurred in 524 patients (6%), including 4 periprocedural deaths (0.05%) from massive cerebral thromboembolism in 2, extrapericardial PV perforation in 1, and an unknown cause in 1 patient. The incidence of cardiac tamponade was 1.2%, and significant PV stenosis >50%, stroke and atypical atrial flutter of new onset occurred in 1.31%, 0.28% and 3.7% of the patients, respectively. A large, prospective, multicenter Italian investigation of ablation-related complications recently reported that in 1,011 AF patients complications occurred in 40 (3.9%): 4 (0.4%) had a stroke, 6 (0.6%) had cardiac tamponade, and 4 (0.4%) had significant PV stenosis >50%. 23 Among our 1,600 patients who underwent extensive encircling isolation of both of the ipsilateral PVs guided by fluoroscopy between 2003 and 2008, overall complications occurred in 23 patients (1.4%): 4 (0.25%) had stroke, 10 (0.6%) had cardiac tamponade, 3 (0.19%) had damage to the peri-esophageal vagal plexus and 6 (0.38%) had transient phrenic nerve (PN) injury; however, there were no cases of significant PV stenosis >50% or atrio-esophageal fistula.Predictors of complications in AF ablation have been reported by some investigators, such as coronary disease, 23 advanced age, 26,27 and female gender. 27 Spragg et al found that the complication rates were higher during the first 100 cases (9%) than during the subsequent 541 cases (4.3%), indicating the salutary effect of institutional or individual operator experience. 27 ThromboembolismThe incidence of thromboembolism caused by AF ablation is 0.28-2.8%. 9,13,22,23,28-32 A worldwide survey reported periprocedural deaths because of massive cerebral thr...

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Novel Imaging Techniques of the Esophagus Enhancing Safety of Left Atrial Ablation

Cited by 43 publications

References 10 publications

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation

Complications in the Catheter Ablation of Atrial Fibrillation

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