Mechanical esophageal displacement during catheter ablation for atrial fibrillation

Jacob S. Koruth, Vivek Y. Reddy, Marc A. Miller, Kalpesh K. Patel, James O. Coffey, Avi Fischer, J. Anthony Gomes, Srinivas Dukkipati, Andre D'Avila, Alexander Mittnacht

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)147-154
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Fingerprint

Catheter Ablation
Atrial Fibrillation
Temperature
Chest Tubes
Hot Temperature
Wounds and Injuries
Endoscopy
Esophageal Diverticulum
Gastroparesis
Esophageal Fistula
Workflow
Pulmonary Veins
Barium
Heart Atria
General Anesthesia
Esophagus
Fistula
Lasers
Safety

Keywords

  • atrial fibrillation
  • catheter ablation
  • esophageal temperature monitoring
  • esophagus
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Koruth, J. S., Reddy, V. Y., Miller, M. A., Patel, K. K., Coffey, J. O., Fischer, A., ... Mittnacht, A. (2012). Mechanical esophageal displacement during catheter ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology, 23(2), 147-154. https://doi.org/10.1111/j.1540-8167.2011.02162.x

Mechanical esophageal displacement during catheter ablation for atrial fibrillation. / Koruth, Jacob S.; Reddy, Vivek Y.; Miller, Marc A.; Patel, Kalpesh K.; Coffey, James O.; Fischer, Avi; Gomes, J. Anthony; Dukkipati, Srinivas; D'Avila, Andre; Mittnacht, Alexander.

In: Journal of Cardiovascular Electrophysiology, Vol. 23, No. 2, 01.02.2012, p. 147-154.

Research output: Contribution to journalArticle

Koruth, JS, Reddy, VY, Miller, MA, Patel, KK, Coffey, JO, Fischer, A, Gomes, JA, Dukkipati, S, D'Avila, A & Mittnacht, A 2012, 'Mechanical esophageal displacement during catheter ablation for atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 23, no. 2, pp. 147-154. https://doi.org/10.1111/j.1540-8167.2011.02162.x
Koruth, Jacob S. ; Reddy, Vivek Y. ; Miller, Marc A. ; Patel, Kalpesh K. ; Coffey, James O. ; Fischer, Avi ; Gomes, J. Anthony ; Dukkipati, Srinivas ; D'Avila, Andre ; Mittnacht, Alexander. / Mechanical esophageal displacement during catheter ablation for atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2012 ; Vol. 23, No. 2. pp. 147-154.
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AU - Fischer, Avi

AU - Gomes, J. Anthony

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KW - esophagus

KW - pulmonary vein isolation

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