Mechanical Esophageal Displacement During Catheter Ablation for Atrial Fibrillation
Article first published online: 13 SEP 2011
© 2011 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 2, pages 147–154, February 2012
How to Cite
KORUTH, J. S., REDDY, V. Y., MILLER, M. A., PATEL, K. K., COFFEY, J. O., FISCHER, A., GOMES, J. A., DUKKIPATI, S., D’AVILA, A. and MITTNACHT, A. (2012), Mechanical Esophageal Displacement During Catheter Ablation for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 23: 147–154. doi: 10.1111/j.1540-8167.2011.02162.x
- Issue published online: 7 FEB 2012
- Article first published online: 13 SEP 2011
- Manuscript received 8 April 2011; Revised manuscript received 17 June 2011; Accepted for publication 8 July 2011.
- atrial fibrillation;
- catheter ablation;
- esophageal temperature monitoring;
- pulmonary vein isolation
Esophageal Deviation in AF Ablation. Objective: To determine the feasibility and safety of esophageal displacement during atrial fibrillation (AF) ablation, to prevent thermal injury.
Background: Patients undergoing AF ablation are at risk of esophageal thermal injury, which ranges from superficial ulceration, to gastroparesis, to the rare but catastrophic atrioesophageal fistula. A common approach to avoid damage is luminal esophageal temperature (LET) monitoring; however, (1) temperature rises mandate interruptions in energy delivery that interrupt workflow and potentially decrease procedural efficacy, and (2) esophageal fistulas have been reported even with LET monitoring.
Methods: A cohort of 20 consecutive patients undergoing radiofrequency (RF) (16 patients) or laser balloon (4 patients) ablation of AF under general anesthesia. After barium instillation, the esophagus was deviated using an endotracheal stylet placed within a thoracic chest tube. LET monitoring was used during catheter ablation. Upper GI endoscopy was performed prior to discharge.
Results: At the pulmonary vein level, leftward deviation measured 2.8 ± 1.6 cm (range: 0.4–5.7) and rightward deviation 2.8 ± 1.8 cm (range: 0.5–4.9). The temperature rose to >38.5 °C in 3/20 (15%) patients. In these 3 patients, there was an average of 2 applications/patient that recorded temperatures >38.5 °C. No patient had a temperature rise > 40 °C. Endoscopy revealed no esophageal ulceration from thermal injury in 18/19 (95%) patients; the sole patient with a thermally mediated ulceration had an unusual esophageal diverticulum fully across the posterior left atrium. Twelve patients (63%) exhibited trauma related to instrumentation with no clinical sequelae.
Conclusions: Mechanical esophageal deviation is feasible and allows for uninterrupted energy delivery along the posterior wall during catheter ablation of AF. J Cardiovasc Electrophysiol, Vol. 23, pp. 147-154, February 2012)