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Long-term mobility of the esophagus in patients undergoing catheter ablation of atrial fibrillation: data from computer tomography and 3D rotational angiography of the left atrium

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Abstract

Purpose

Computed tomography (CT) and 3D rotational angiography (3DRA) of the left atrium (LA) are used to evaluate the esophagus prior to radiofrequency ablation for atrial fibrillation. The aim of this study was to compare preprocedural and periprocedural views of the esophagus and the left atrium.

Methods

From September 2011 to August 2012, 3DRA and CT of the LA were performed on 56 patients before they underwent catheter ablation of atrial fibrillation. The 3DRA was performed periprocedurally, and the CT was performed an average of 20 days prior to the procedure. 3D models of the LA and the esophagus were then segmented on the EP Navigator V 3.1 workstation. Five positions of the esophagus, A–E, in order from left to right, were evaluated.

Results

The most common position of the esophagus was behind the left part of the LA (CT, position B (n = 26)) and behind the central part of the LA (3DRA, position C (n = 21)). The maximum shift of the esophagus was three positions, and the average shift was 0.857 ± 0.766 of a position. There was a shift of one position in 44.6 % of the patients, two positions in 17.9 %, and three positions in 1.8 %. A statistically significant difference was found between the positions of the esophagus when the 3DRA and CT evaluations were compared.

Conclusions

The most common position of the esophagus was behind the middle and left part of the LA. The outpatient views of the esophagus obtained before ablation did not reflect the position of the esophagus at the beginning of the procedure.

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References

  1. Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 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. Journal of Interventional Cardiac Electrophysiology, 33(4), 171–257.

    Article  PubMed  Google Scholar 

  2. Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine, 339(10), 659–666.

    Article  PubMed  Google Scholar 

  3. Haïssaguerre, M., Jaïs, P., Shah, D. C., Gencel, L., Pradeau, V., Garrigues, S., et al. (1996). Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 7(12), 1132–1144.

    Article  PubMed  Google Scholar 

  4. Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2009). Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. Journal of the American College of Cardiology, 53(19), 1798–1803.

    Article  PubMed  Google Scholar 

  5. Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 3(1), 32–38.

    Article  PubMed  Google Scholar 

  6. Ghia, K. K., Chugh, A., Good, E., Pelosi, F., Jongnarangsin, K., Bogun, F., et al. (2009). A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. Journal of Interventional Cardiac Electrophysiology, 24(1), 33–36.

    Article  PubMed  Google Scholar 

  7. Cury, R. C., Abbara, S., Schmidt, S., Malchano, Z. J., Neuzil, P., Weichet, J., et al. (2005). Relationship of the oesophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation. Heart Rhythm, 2(12), 1317–1323.

    Article  PubMed  Google Scholar 

  8. Lemola, K., Sneider, M., Desjardins, B., Case, I., Han, J., Good, E., et al. (2004). Computed tomographic analysis of the anatomy of the left atrium and the oesophagus: implications for left atrial catheter ablation. Circulation, 110(24), 3655–3660.

    Article  PubMed  Google Scholar 

  9. Ejima, K., Shoda, M., Yagishita, D., Futagawa, K., Yashiro, B., Sato, T., et al. (2010). Image integration of three-dimensional cone-beam computed tomography angiogram into electroanatomical mapping system to guide catheter ablation of atrial fibrillation. Europace, 12(1), 45–51.

    Article  PubMed  Google Scholar 

  10. Orlov, M. V., Hoffmeister, P., Chaudhry, G. M., Almasry, I., Gijsbers, G. H., Swack, T., et al. (2007). Three-dimensional rotational angiography of the left atrium and oesophagus—a virtual computed tomography scan in the electrophysiology lab? Heart Rhythm, 4(1), 37–43.

    Article  PubMed  Google Scholar 

  11. Kobza, R., Auf der Maur, C., Kurtz, C., Hoffmann, A., Allgayer, B., & Erne, P. (2007). Oesophagus imaging for radiofrequency ablation of atrial fibrillation using a dual-source computed tomography system: preliminary observations. Journal of Interventional Cardiac Electrophysiology, 19(3), 167–170.

    Article  PubMed  Google Scholar 

  12. Piorkowski, C., Hindricks, G., Schreiber, D., Tanner, H., Weise, W., Koch, A., et al. (2006). Electroanatomic reconstruction of the left atrium, pulmonary veins, and oesophagus compared with the “true anatomy” on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation. Heart Rhythm, 3(3), 317–327.

    Article  PubMed  Google Scholar 

  13. Kottkamp, H., Piorkowski, C., Tanner, H., Kobza, R., Dorszewski, A., Schirdewahn, P., et al. (2005). Topographic variability of the oesophageal left atrial relation influencing ablation lines in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 16(2), 146–150.

    Article  PubMed  Google Scholar 

  14. Kennedy, R., Good, E., Oral, H., Huether, E., Bogun, F., Pelosi, F., et al. (2008). Temporal stability of the location of the oesophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter. Journal of Cardiovascular Electrophysiology, 19(4), 351–355.

    Article  PubMed  Google Scholar 

  15. Daoud, E. G., Hummel, J. D., Houmsse, M., Hart, D. T., Weiss, R., Liu, Z., et al. (2008). Comparison of computed tomography imaging with intraprocedural contrast oesophagram: implications for catheter ablation of atrial fibrillation. Heart Rhythm, 5(7), 975–980.

    Article  PubMed  Google Scholar 

  16. Nölker, G., Gutleben, K. J., Marschang, H., Ritscher, G., Asbach, S., Marrouche, N., et al. (2008). Three-dimensional left atrial and oesophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: accuracy of a novel modality in comparison with multislice computed tomography. Heart Rhythm, 5(12), 1651–1657.

    Article  PubMed  Google Scholar 

  17. Lehar, F., Starek, Z., Jez, J., Novak, M., Wolf, J., Kruzliak, P., et al. (2013). Rotational atriography of left atrium—a new imaging technique used to support left atrial radiofrequency ablation. Interv Akut Kardiol, 12(4), 184–189.

    Google Scholar 

  18. Li, J. H., Haim, M., Movassaghi, B., Mendel, J. B., Chaudhry, G. M., Haffajee, C. I., et al. (2009). Segmentation and registration of three-dimensional rotational angiogram on live fluoroscopy to guide atrial fibrillation ablation: a new online imaging tool. Heart Rhythm, 6(2), 231–237.

    Article  PubMed  Google Scholar 

  19. Thiagalingam, A., Manzke, R., D’Avila, A., Ho, I., Locke, A. H., Ruskin, J. N., et al. (2008). Intraprocedural volume imaging of the left atrium and pulmonary veins with rotational X-ray angiography: implications for catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19(3), 293–300.

    Article  PubMed  Google Scholar 

  20. Kobza, R., Schoenenberger, A. W., & Erne, P. (2009). Esophagus imaging for catheter ablation of atrial fibrillation: comparison of two methods with showing of esophageal movement. Journal of Interventional Cardiac Electrophysiology, 26(3), 159–164.

    Article  PubMed  Google Scholar 

  21. Summerton, S. L. (2005). Radiographic evaluation of oesophageal function. Gastrointestinal Endoscopy Clinics of North America, 15(2), 231–242.

    Article  PubMed  Google Scholar 

  22. Sherzer, A. I., Feigenblum, D. Y., Kulkarni, S., Pina, J. W., Casey, J. L., Salka, K. A., et al. (2007). Continuous nonfluoroscopic localization of the esophagus during radiofrequency catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(2), 157–160.

    Article  PubMed  Google Scholar 

  23. Good, E., Oral, H., Lemola, K., Han, J., Tamirisa, K., Igic, P., et al. (2005). Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. Journal of the American College of Cardiology, 46(11), 2107–2110.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Grant of the European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123).

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Correspondence to Zdeněk Stárek.

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The study received the approval from the ethics committee of our institution.

Competing interests

The authors declare that they have no conflicts of interest.

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Stárek, Z., Lehar, F., Jež, J. et al. Long-term mobility of the esophagus in patients undergoing catheter ablation of atrial fibrillation: data from computer tomography and 3D rotational angiography of the left atrium. J Interv Card Electrophysiol 46, 81–87 (2016). https://doi.org/10.1007/s10840-016-0121-x

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  • DOI: https://doi.org/10.1007/s10840-016-0121-x

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