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Computed tomographic analysis of the esophagus, left atrium, and pulmonary veins: implications for catheter ablation of atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose:

The aim of this study was to investigate the anatomic relationship around the left atrium (LA) and to provide clinical information to help avoid the risk of an atrio-esophageal fistula during atrial fibrillation (AF) ablation.

Methods:

The multidetector spiral computed tomography images of 77 male patients (mean age, 54 ± 9 years) with drug-refractory AF and 37 male control subjects (mean age, 50 ± 11 years) were analyzed. We measured the following variables: (1) distance between the ostia of the pulmonary veins (PVs) and the ipsilateral esophageal border, (2) presence of a pericardial fat pad around each PV, and (3) contact width/length and presence of a fat pad between the LA and the esophagus.

Results:

The distance between the esophagus and the ostia of right superior PV, right inferior PV (RIPV), left superior PV, and left inferior PV (LIPV) was 27.2 ± 9.4 mm, 22.9 ± 10.3 mm, 2.7 ± 9.4 mm, and 7.1 ± 8.8 mm, respectively. A fat pad between the esophagus and the superior PV was present in more than 90% of the subjects in both groups. However, the fat pad around inferior PV was present less frequently in the patients than in the control group (p = 0.011, RIPV; p < 0.001, LIPV). The average length of the LA–esophagus contact in the patients and the control group subjects was 26.2 ± 10.4 and 18.5 ± 5.1 mm, respectively (p < 0.001).

Conclusion:

Caution should be exercised when ablating the LIPV because the esophagus is located in close proximity to the left-sided PV and most of the inferior PVs in patients with AF are not covered with fat pads.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea

    Sung-Won Jang, Beom-June Kwon, Min-Seok Choi, Dong-Bin Kim, Woo-Seung Shin, Eun Joo Cho, Ji-Hoon Kim, Yong-Seog Oh, Man-Young Lee, Tai-Ho Rho & Jae-Hyung Kim

  2. Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, South Korea

    Bae-Young Lee, Hyo-Lim Kim, Jung-Im Jung & Kyung-Sup Song

  3. Department of Radiology, The Catholic University of Korea St. Paul’s Hospital, Jeonnong 1-Dong, Dongdaemun-Gu, Seoul, 130-709, Republic of Korea

    Bae-Young Lee

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  1. Sung-Won Jang
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  2. Beom-June Kwon
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  14. Jung-Im Jung
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  15. Kyung-Sup Song
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Correspondence to Bae-Young Lee.

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Jang, SW., Kwon, BJ., Choi, MS. et al. Computed tomographic analysis of the esophagus, left atrium, and pulmonary veins: implications for catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 32, 1–6 (2011). https://doi.org/10.1007/s10840-011-9594-9

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  • DOI: https://doi.org/10.1007/s10840-011-9594-9

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