Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

Cheryl Teres; David Soto-Iglesias; Diego Penela; Beatriz Jáuregui; Augusto Ordoñez; Alfredo Chauca; Jose Miguel Carreño; Claudia Scherer; Marina Huguet; Carlos Ramírez; José Torres Mandujano; Giuliana Maldonado; Alejandro Panaro; Julio Carballo; Óscar Cámara; Jose-Tomás Ortiz-Pérez; Antonio Berruezo

doi:10.1016/j.hroo.2022.02.007

Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

Heart Rhythm O2. 2022 Feb 13;3(3):252-260. doi: 10.1016/j.hroo.2022.02.007. eCollection 2022 Jun.

Authors

Cheryl Teres^{1

2}, David Soto-Iglesias¹, Diego Penela¹, Beatriz Jáuregui¹, Augusto Ordoñez¹, Alfredo Chauca¹, Jose Miguel Carreño¹, Claudia Scherer¹, Marina Huguet¹, Carlos Ramírez¹, José Torres Mandujano¹, Giuliana Maldonado¹, Alejandro Panaro¹, Julio Carballo¹, Óscar Cámara³, Jose-Tomás Ortiz-Pérez¹, Antonio Berruezo¹

Affiliations

¹ Heart Institute, Teknon Medical Center, Barcelona, Spain.
² Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland.
³ PhySense group, BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.

Abstract

Background: Atrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent.

Objectives: The purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure.

Methods: Esophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of first pulmonary vein isolation and redo intervention (redo group) was segmented with ADAS 3D™ to compare the stability of the atrioesophageal isodistance prints. Second, 3 imaging modalities were compared for the same procedure (multimodality group): (1) preprocedural MDCT; (2) intraprocedural fluoroscopy obtained with the transesophageal echocardiographic probe in place with CARTOUNIVU™; and (3) esophageal fast anatomic map (FAM) at the end of the procedure. Esophageal position correlation between different imaging techniques was computed in MATLAB using semiautomatic segmentation analysis.

Results: Thirty-five redo patients were analyzed and showed a mean atrioesophageal distance of 1.2 ± 0.6 mm and a correlation between first and redo procedure esophageal fingerprint of 91% ± 5%. Only 3 patients (8%) had a clearly different position. The multi-imaging group was composed of 100 patients. Esophageal position correlation between MDCT and CARTOUNIVU was 82% ± 10%; between MDCT and esophageal FAM was 80% ± 12%; and between esophageal FAM and CARTOUNIVU was 83% ± 15%.

Conclusion: There is high stability of esophageal position between procedures and from the beginning to the end of a procedure. Further research is undergoing to test the clinical utility of the esophageal fingerprinted isodistance map to the posterior atrial wall.

Keywords: Atrial fibrillation; Atrial wall thickness; Atrioesophageal fistula; Catheter ablation; Esophageal position.