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

Teres, C ; Soto-Iglesias, D ; Penela, D ; Jáuregui, B (Universidad de Zaragoza) ; Ordoñez, A ; Chauca, A ; Carreño, JM ; Scherer, C ; Huguet, M ; Ramírez, C ; Mandujano, JT ; Maldonado, G ; Panaro, A ; Carballo, J ; Cámara, Ó ; Ortiz-Pérez, JT ; Berruezo, A

Resumen: 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.

Idioma: Inglés

DOI: 10.1016/j.hroo.2022.02.007

Año: 2022

Publicado en: Heart Rhythm O2 3 (2022), 252 - 260
ISSN: 2666-5018

Factor impacto CITESCORE: 1.8 - Medicine (Q3)

Factor impacto SCIMAGO: 0.709 - Cardiology and Cardiovascular Medicine (Q2)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)