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Esophageal Contour Changes during Cryoablation of Atrial Fibrillation
Author(s) -
HERWEG BENGT,
ALI RIAS,
KHAN NADIM,
ILERCIL ARZU,
BAROLD S. S.
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02356.x
Subject(s) - medicine , esophagus , ablation , atrial fibrillation , ostium , cryoablation , pulmonary vein , catheter ablation , ablation of atrial fibrillation , radiology , cardiology
Background: We have observed contour changes of the barium‐filled esophagus during atrial fibrillation (AF) ablation with cryo‐energy delivered in direct proximity to the esophagus.Objective: To evaluate the frequency, location, and severity of esophageal contour changes during cryo‐energy application close to the esophagus.Methods: We retrospectively analyzed cine‐fluoroscopic images acquired during hybrid cryo‐radiofrequency AF ablation in 100 consecutive patients with cryo‐energy delivered only in direct proximity to the esophagus.Results: Esophageal contour changes were observed in 28 (32%) of 89 patients (and 74 [6.2%] of 1,191 of all cryo applications). They were more frequent in the left common pulmonary vein (PV) (50%) and less so in the right common PV and the upper PVs (4–5%). The distance of the ablation catheter from the endoesophageal contour prior to cryo‐energy applications associated with contour changes was 1.8 ± 1.5 mm, which increased to 4.1 ± 1.6 mm at the time of peak contour change (P < 0.001). The esophageal contour deformation was 2.3 ± 0.9 mm. There were no apparent complications related to cryo‐energy application for 3–4 minutes, even if associated with contour changes.Conclusion: Esophageal contour changes were observed in >6% of cryo applications in direct proximity to the esophagus (32% of patients) and were most frequent in the posterior aspect of the left common and right lower PV ostium when cryo‐energy was delivered at a distance of ≤5 mm from the esophageal contrast silhouette. No overt esophageal injury occurred. However, the safety of cryo‐energy application in direct proximity to the esophagus remains to be further confirmed.