Reducing Complications in Cardiac Ablation Procedures

A new technique recommends using continuous nonfluoroscopic imaging to localize the esophagus during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF).

Physicians at Englewood Hospital and Medical Center (NJ, USA) examined 27 patients who underwent 33 pulmonary vein encirclement procedures. All the patients received general anesthesia with inhalational agents. A diagnostic electrophysiologic catheter was inserted into the esophagus, and a virtual esophageal tube was created using an electroanatomic mapping system. Areas of close proximity between the left atrium and esophagus were easily identified. In 12 of 27 patients esophageal proximity to the pulmonary veins identified high-risk cases, and the planned procedure was modified to avoid esophageal injury. The researchers found that among patients who received general anesthesia, the esophageal position appeared to remain static, suggesting that one initial virtual image is sufficient for the duration of an ablation procedure. The new technique is described in a study published in the January 2007 edition of the Journal of Cardiovascular Electrophysiology (JCE).

"This new technique maximizes the effectiveness of the ablation procedure while minimizing the risk of esophageal injury,” said co-author Grant R. Simons, M.D., chief of cardiac electrophysiology at Englewood. "Damage to the esophagus is a rare but very serious complication which is associated with RFA of atrial fibrillation. Our findings present a significant advance in operative safety, and we expect that other centers will adopt this technique.”

Atrial-esophageal fistula formation is a dreaded complication of radiofrequency catheter ablation for AF. Esophageal localization is of potential value in avoiding lesion placement where the left atrium is juxtaposed to the esophagus.



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Englewood Hospital and Medical Center