Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the “true anatomy” on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation

Piorkowski, Christopher; Hindricks, Gerhard; Schreiber, Doreen; Tanner, Hildegard; Weise, W; Koch, Alexander; Gerds‐Li, Jin‐Hong; Kottkamp, Hans

doi:10.1016/j.hrthm.2005.11.027

Cited by 94 publications

(65 citation statements)

References 13 publications

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“…18 -20 The exact position of the esophagus and its relation to the posterior wall may be different at the time of the ablation procedure compared with the preprocedurally acquired CT scan, perhaps because of the fasting state and the resulting fluid changes. Yet, Piorkowski et al 21 showed a high concordance between the esophageal-LA relationship on an electroanatomic reconstruction and a CT-scan in a similar setting. The mobility of the esophagus, however, cannot be monitored by this approach.…”

Section: Zellerhoff Et Al Esophageal and Mediastinal Changes After Pvimentioning

confidence: 97%

“…22,23 However, there are conflicting data concerning the mobility of the esophagus in the segments relevant to the ablation procedure. Piorkowski et al 21 described a degree of mobility of the esophagus toward the roof of the LA using an in vivo 3D tagging of the esophagus and a stable anatomic relationship at the midportion and the inferior LA. In contrast to this, Good et al 23 demonstrated a significant mobility of the esophagus also in these segments, visualizing the esophagus by a barium swallow.…”

Section: Zellerhoff Et Al Esophageal and Mediastinal Changes After Pvimentioning

confidence: 99%

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Damage to the Esophagus After Atrial Fibrillation Ablation

Zellerhoff¹,

Ullerich²,

Lenze³

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-Radiofrequency catheter ablation is increasingly used in the treatment of atrial fibrillation. Esophageal wall changes varying from erythema to ulcers have been described by endoscopy in up to 47% of patients following pulmonary vein isolation (PVI). Although esophageal changes are frequently reported, the development of a left atrial (LA)-esophageal fistula is fortunately rare. Nevertheless, mucosal changes may just represent "the tip of the iceberg." The aim of this study was, therefore, to investigate the more subtle changes of and injuries to the posterior wall of the LA, the periesophageal and mediastinal connective tissue, and the whole wall of the esophagus, including mucosal changes by esophagogastroduodenoscopy (EGD) combined with radial endosonography (EUS). Methods and Results-Twenty-nine patients (7 females; mean age, 57.7Ϯ10.5 years [range, 23-75 years]) underwent EGD and EUS before and after PVI within 48 hours. PVI was performed as a circumferential antral isolation of the septal and lateral pulmonary veins guided by a decapolar circular mapping catheter using a 3-dimensional mapping system with the integration of a preprocedurally acquired computed tomography scan of the left atrium. The maximum power applied was 30 W, with an open-irrigated catheter using a maximum flow rate of 30 mL/min. In all patients, the esophagus was reconstructed using the same computed tomography scan and displayed during the ablation procedure. In case of newly detected periesophageal changes, EGD and EUS were repeated 1 week after the PVI. In all patients, a regular contact area between the LA and the esophagus could be demonstrated before PVI. The mean vertical contact length was 4.4Ϯ1.5 cm (range, 2-10 cm); and the mean distance between the anterior wall of the esophagus and the endocardium was 2.6Ϯ0.8 mm (range, 1.4 -4.0 mm). After PVI, morphological changes of the periesophageal connective tissue and the posterior wall of the LA were diagnosed by endosonography in 8 patients (27%; 95% confidence interval, 12.73-47.24). No mucosal changes of the esophagus in terms of erythema or ulcers were found. In all but one patient (who refused the control), all periesophageal and atrial changes had resolved within 1 week. No atrioesophageal fistula occurred during follow-up (mean follow-up, 294Ϯ110 days [range, 36 -431 days]). Conclusions-Mucosal changes of the esophagus after PVI-like ulcers or erythema could not be demonstrated, yet structural changes of the mediastinum, which were only visible by endosonography, occurred in 27% of patients in the present study. This may indicate a higher than expected periesophageal injury because of PV ablation. Endosonography might prove to be a sensitive and reliable tool in the follow-up after PVI. (Circ Arrhythm Electrophysiol. 2010;3:155-159.)

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Section: Zellerhoff Et Al Esophageal and Mediastinal Changes After Pvimentioning

confidence: 97%

Section: Zellerhoff Et Al Esophageal and Mediastinal Changes After Pvimentioning

confidence: 99%

Damage to the Esophagus After Atrial Fibrillation Ablation

Zellerhoff¹,

Ullerich²,

Lenze³

et al. 2010

Circ: Arrhythmia and Electrophysiology

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“…The algorithm to register the computed tomography (CT) model of the LA into the EAMS has been reported previously. 7 Briefly, the 4 pulmonary veins (PVs) were reconstructed as individual NavX-EnSite anatomies and, subsequently, served as the anchor structures to register the 3D CT image. Fine adjustment of image integration was achieved with further fiducial points at predefined locations within the LA body.…”

Section: General Procedures Setupmentioning

confidence: 99%

“…Fine adjustment of image integration was achieved with further fiducial points at predefined locations within the LA body. 7 In all patients, catheter navigation was facilitated using a steerable sheath (Agilis, St Jude Medical, Inc). …”

Section: General Procedures Setupmentioning

confidence: 99%

Ablation of Atrial Fibrillation Using Novel 4-Dimensional Catheter Tracking Within Autoregistered Left Atrial Angiograms

Rolf

Sommer

Gaspar

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…This helps aid navigation and orient the operator to locations and anatomies that are not as easily perceptible by 2-dimensional fluoroscopy. 10 Because catheter tip localization is nearly real time, navigation can be performed with these systems alone. This may help reduce fluoroscopy exposure to the patient and operator.…”

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confidence: 99%

New Technologies in Atrial Fibrillation Ablation

Burkhardt

Natale

2009

Circulation

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he treatment of atrial fibrillation has changed greatly in the past decade. Not long ago, the scientific community argued the benefits of a rate-control strategy versus a rhythmcontrol strategy. 1 This argument was always hampered by the relative ineffectiveness of the antiarrhythmic medications used as rhythm-control agents. Ablation therapy for the treatment of atrial fibrillation has quickly evolved. Originally, ablation was focused on finding triggers of atrial fibrillation in the pulmonary veins. 2,3 Now, ablation offers a potential curative strategy for patients with paroxysmal, persistent, or permanent atrial fibrillation. Recent data continue to show that atrial fibrillation ablation is superior to the currently available antiarrhythmic medications in the maintenance of sinus rhythm, and the Food and Drug Administration has approved devices labeled for the ablation of atrial fibrillation. 4 -6 It is estimated that Ͼ2 million people in the United States have atrial fibrillation. 7 Although the number of atrial fibrillation ablations continues to increase year after year, offering this therapy to all potential candidates is impossible because of several limitations. 8,9 A finite number of fellows are being trained in programs that offer a great deal of experience in atrial fibrillation ablation, and there is limited opportunity for practicing electrophysiologists to learn new techniques. Unlike supraventricular tachycardia ablation, atrial fibrillation ablation requires greater technical skill, significantly more lesions, and time. Like many other medical procedures, technological innovation is likely to be a contributing factor in making atrial fibrillation ablation a more commonplace and widely practiced therapy.Navigating the complex anatomy of the left atrium is also difficult to master. Imaging technologies have been used to orient the operator to the anatomy and the location of the ablation catheters in this anatomy. With fluoroscopy alone, it is difficult to determine anterior versus posterior orientation or the presence of the catheter in a pulmonary vein versus the left atrial appendage. Intracardiac echocardiography (ICE) provides 2-dimensional navigation assistance and excellent anatomic detail; however, it is difficult to locate the catheter tip at all times in the echocardiography field. Without 3-dimensional (3D) imaging, navigation with ICE alone is also difficult. Electroanatomic mapping (EAM) systems offer a 3D view and nearly real-time catheter tip localization within a created construct of the left atrium, but the data are heavily dependent on the input of the operator and cartographer. Newer technology has merged these 2 imaging modalities to offer the best of both worlds.Remotely obtained computed tomography (CT) imaging of the left atrium has been performed to define the complex anatomy of the left atrium. This can be integrated into EAMs or imaging systems to aid in navigation and procedure planning. However, conditions at the time of CT may be different from those at the time of a...

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Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the “true anatomy” on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation

Cited by 94 publications

References 13 publications

Damage to the Esophagus After Atrial Fibrillation Ablation

Damage to the Esophagus After Atrial Fibrillation Ablation

Ablation of Atrial Fibrillation Using Novel 4-Dimensional Catheter Tracking Within Autoregistered Left Atrial Angiograms

New Technologies in Atrial Fibrillation Ablation

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