Document Detail


Findings and outcome of fluoroscopic visualization of the oesophageal course during catheter ablation of atrial fibrillation.
MedLine Citation:
PMID:  21398313     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims The close topographic relationship between the left atrial posterior wall (LAPW) and the oesophagus creates a potential hazard of thermal lesions to the oesophagus during radiofrequency (RF) catheter ablation of atrial fibrillation (AF). The purpose of the study was to describe topographic relation of the oesophagus behind the left atrium in the ablation situation, and to evaluate the clinical outcome of subsequent modifications to the strategy using continuous real-time fluoroscopic visualization of the oesophageal course. Methods and results In 214 consecutive patients, a gastric tube (GT) was inserted before circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal (n= 160) or persistent (n= 54) AF.  In the real-time mapping situation at the LAPW, the tissue interface between catheter tip and oesophagus lumen measured only 2.9 ± 1.9 mm, and 2.5 ± 1.2 mm at the level of the upper and lower pulmonary vein (PV) ostia, respectively. Modifications of the intended antral CPVI approach due to an oesophageal course close to the left or right PV ostia (in 76.6% of patients) were associated with reduced success rate (sustained sinus rhythm) after one (54.9 vs. 72.0%, P = 0.03), or 1-3 ablation procedures (85.4 vs. 96.0%, P = 0.04) during a mean follow-up of 13 ± 10 months. Conclusion Continuous real-time fluoroscopic visualization using a GT emphasizes the very small distance of the catheter tip and oesophageal lumen that may be present in the real-ablation situation and may help to avoid RF lesion application in close proximity to the oesophagus. However, accordant modification of AF ablation strategy may reduce efficacy of the procedure.
Authors:
Sascha Rolf; Leif-Hendrik Boldt; Abdul S Parwani; Alexander Wutzler; Martin Huemer; Daniela Blaschke; Erik Herberger; Wilhelm Haverkamp
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-11
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, D-13553 Berlin, Germany.
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