Posterior left atrial–esophageal relationship throughout the cardiac cycle

Sra, Jasbír; Krum, David; Malloy, Angela; Bhatia, Atul; Cooley, Ryan; Blanck, Zalmen; Dhala, Anwer; Anderson, Alfred J.; Akhtar, Masood

doi:10.1007/s10840-006-9031-7

Cited by 14 publications

(5 citation statements)

References 10 publications

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“…Sra et al. have shown that the esophagus is in contact with the posterior left atrium throughout the cardiac cycle but may run toward either the left or right pulmonary veins. In every case of our study, the esophageal position allowed study of the left atrium with no patient excluded due to the course of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

“…It has long been known that the heart can be paced through the esophagus in emergencies and all ablating electrophysiologists are aware of the dangers of esophageal trauma with left atrial ablation. Computed tomography (CT) studies have shown that the esophagus is in contact with the left atrium throughout the cardiac cycle . It may run a course closer to the right or left pulmonary veins, but it always contacts the posterior left atrium.…”

Section: Rationale For the Studymentioning

confidence: 99%

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The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

Furniss

Panagopoulos

Newcomb

et al. 2018

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

Section: Rationale For the Studymentioning

confidence: 99%

The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

Furniss

Panagopoulos

Newcomb

et al. 2018

Pacing Clinical Electrophis

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show abstract

“…Unfortunately, since the esophagus is a mobile organ, the preoperative esophageal location may not accurately reflect its location at the time of ablation. Although short-term esophageal motion during the cardiac cycle does not seem to be critical, 21 a series of studies have reported conflicting results on the magnitude of esophageal position change across serial imaging studies, with some suggesting minimal motion, 22,23 and others reporting large position changes and concluding to the inefficacy of a personalization strategy based on prior imaging. 10,24,25 None of these prior studies have assessed the actual LA-esophagus distance, but rather the projection of the entire course of the esophagus on the LA.…”

Section: Use Of Preoperative Imaging To Prevent Esophageal Injurymentioning

confidence: 99%

Preoperative personalization of atrial fibrillation ablation strategy to prevent esophageal injury: Impact of changes in esophageal position

Nakatani

Nuñez‐Garcia

Cheniti

et al. 2022

Cardiovasc electrophysiol

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Introduction Due to changes in esophageal position, preoperative assessment of the esophageal location may not mitigate the risk of esophageal injury in catheter ablation for atrial fibrillation (AF). This study aimed to assess esophageal motion and its impact on AF ablation strategies. Methods and Results Ninety‐seven AF patients underwent two computed tomography (CT) scans. The area at risk of esophageal injury (AAR) was defined as the left atrial surface ≤3 mm from the esophagus. On CT1, ablation lines were drawn blinded to the esophageal location to create three ablation sets: individual pulmonary vein isolation (PVI), wide antral circumferential ablation (WACA), and WACA with linear ablation (WACA + L). Thereafter, ablation lines for WACA and WACA + L were personalized to avoid the AAR. Rigid registration was performed to align CT1 onto CT2, and the relationship between ablation lines and the AAR on CT2 was analyzed. The esophagus moved by 3.6 [2.7 to 5.5] mm. The AAR on CT2 was 8.6 ± 3.3 cm2, with 77% overlapping that on CT1. High body mass index was associated with the AAR mismatch (standardized β 0.382, p < .001). Without personalization, AARs on ablation lines for individual PVI, WACA, and WACA + L were 0 [0–0.4], 0.8 [0.5–1.2], and 1.7 [1.2–2.0] cm2. Despite the esophageal position change, the personalization of ablation lines for WACA and WACA + L reduced the AAR on lines to 0 [0–0.5] and 0.7 [0.3–1.0] cm2 (p < .001 for both). Conclusion The personalization of ablation lines based on a preoperative CT reduced ablation to the AAR despite changes in esophageal position.

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“…The esophageal mucus with its intrinsic clearance acts as conductive electrolyte. Due to the close proximity to the heart [9], esophageal electrodes sense both atrial as well as ventricular electrical signals with high quality [10].…”

Section: Introductionmentioning

confidence: 99%

Esophageal ECG: The challenge of electrode design

Niederhäuser

Haeberlin

Vogel

et al. 2011

2011 IEEE International Symposium on Medical Measurements and Applications

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Abstract-Two commercially available electrode catheters are examined for their suitability in esophageal long-term ECG recordings. Both, electrical sensing characteristics as well as clinical acceptance were investigated in a clinical study including inpatients with cardiovascular diseases. In total, 31 esophageal ECG were obtained in 36 patients. Results showed that esophageal electrodes were well tolerated by the patients. Hemispherical electrodes with higher diameter required more insertion attempts and were associated with increased failure rates as compared to cylindrical electrodes. In contrast, the higher surface area of hemispherical electrodes resulted in significantly higher signal-to-noise ratio. Contact impedance was equal for both electrode types, but esophageal electrodes had lower impedance if compared with skin electrodes.

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Posterior left atrial–esophageal relationship throughout the cardiac cycle

Cited by 14 publications

References 10 publications

The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

Preoperative personalization of atrial fibrillation ablation strategy to prevent esophageal injury: Impact of changes in esophageal position

Esophageal ECG: The challenge of electrode design

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