Dataset Information

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

ABSTRACT:

Background

Atrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent.

Objectives

The purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure.

Methods

Esophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of first pulmonary vein isolation and redo intervention (redo group) was segmented with ADAS 3D™ to compare the stability of the atrioesophageal isodistance prints. Second, 3 imaging modalities were compared for the same procedure (multimodality group): (1) preprocedural MDCT; (2) intraprocedural fluoroscopy obtained with the transesophageal echocardiographic probe in place with CARTOUNIVU™; and (3) esophageal fast anatomic map (FAM) at the end of the procedure. Esophageal position correlation between different imaging techniques was computed in MATLAB using semiautomatic segmentation analysis.

Results

Thirty-five redo patients were analyzed and showed a mean atrioesophageal distance of 1.2 ± 0.6 mm and a correlation between first and redo procedure esophageal fingerprint of 91% ± 5%. Only 3 patients (8%) had a clearly different position. The multi-imaging group was composed of 100 patients. Esophageal position correlation between MDCT and CARTOUNIVU was 82% ± 10%; between MDCT and esophageal FAM was 80% ± 12%; and between esophageal FAM and CARTOUNIVU was 83% ± 15%.

Conclusion

There is high stability of esophageal position between procedures and from the beginning to the end of a procedure. Further research is undergoing to test the clinical utility of the esophageal fingerprinted isodistance map to the posterior atrial wall.

SUBMITTER: Teres C

PROVIDER: S-EPMC9207737 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

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

Teres Cheryl C Soto-Iglesias David D Penela Diego D Jáuregui Beatriz B Ordoñez Augusto A Chauca Alfredo A Carreño Jose Miguel JM Scherer Claudia C Huguet Marina M Ramírez Carlos C Mandujano José Torres JT Maldonado Giuliana G Panaro Alejandro A Carballo Julio J Cámara Óscar Ó Ortiz-Pérez Jose-Tomás JT Berruezo Antonio A

Heart rhythm O2 20220213 3

<h4>Background</h4>Atrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent.<h4>Objectives</h4>The purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure.<h4>Methods</h4>Esophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of firs ...[more]

PMID: 35734293

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Project description:Esophageal thermal injury is one of the most feared risks of ablation of the posterior left atrium despite the various devices used to monitor esophageal temperature or deviate the esophagus. Reactive cooling, in which cold water is manually instilled into the esophagus via an orogastric tube in response to rises in luminal esophageal temperature (LET), has been used by operators, but the availability of a dedicated esophageal cooling device offers the ability to provide proactive esophageal cooling without having to react to individual temperature rises in the esophagus. The objective of this study was to evaluate the feasibility of using a commercially available esophageal cooling device to provide esophageal protection during left atrial catheter ablation, then to compare this approach to standard LET monitoring with reactive cooling via manual cold-water instillation. In this study, we randomized 6 patients undergoing catheter ablation for atrial fibrillation. Three patients received the standard of care for our site (use of a single-sensor temperature probe, with adjunct ice-water instillation for any temperature increases of >1°C). Three patients underwent standard ablation after placement of the esophageal cooling device at a circulating water temperature of 4°C, without the use of any esophageal temperature monitoring. All patients underwent transesophageal echocardiography and esophagogastroduodenoscopy on the day prior to the ablation, followed by a second esophagogastroduodenoscopy the day after. The 6 patients in this study were enrolled between March and August 2018. In the 3 control patients, 1 had no evidence of esophageal mucosal damage, 1 had diffuse sloughing of the esophageal mucosa and multiple ulcerations, and 1 had a superficial ulcer with a large clot. Both patients with lesions were classified as 2a cases using the Zargar grading scheme for caustic injury. In the 3 patients treated with the cooling device, 1 had no evidence of esophageal mucosal damage, 1 had esophageal erythema (Zargar grade 1), and 1 had a solitary Zargar grade 2a lesion. At 3 months of follow-up, 1 patient in each group had recurrence of atrial fibrillation. Although a number of subsequent studies have confirmed the reduction of esophageal injury with the use of proactive esophageal cooling, this study is the only one to date to compare reactive cooling (via manual cold-water instillation) and proactive cooling (via a dedicated esophageal cooling device). Moreover, this is the first study to support the feasibility of using a dedicated cooling device for this purpose and provides the basis for further investigation.

Dataset Information

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

Background

Objectives

Methods

Results

Conclusion

Publications

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

Similar Datasets

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