The change in the position of the esophagus during radiofrequency ablation of the pulmonary veins is minimal according to esophagography

Abstract

Aim. To study the change in the position of the esophagus during radiofrequency ablation of the pulmonary veins (RFA PV) using esophagographyMethods. The period of the study is from August 2022 to January 2023 inclusive. The study is a single-center observational non-randomized study. The study included 191 patients. RFA PV were performed under conscious sedation with dexmedetomidine and fentanyl. The patients were available for verbal contact throughout the operation. After performing a transeptal puncture, esophagography was performed in the LAO 30° projection using 10 ml of Omnipac water-soluble contrast agent (GE Healthcare Ireland). At the end of the operation, esophagography was performed repeatedly. The position of the esophagus was determined relative to the shadow of the spine. Measurements were carried out at three levels: the upper one at the intersection of the esophagus and the roof of the left atrium, the lower one at the intersection with the ring of the mitral valve; the middle level at the middle of the distance between the upper and lower measurements. The width of the contrasted lumen of the esophagus was measured at the same levels. Lateral displacement of the esophagus was defined as the difference in the values of measurements of the position of the lateral and medial boundaries of the esophageal shadow on esophagograms obtained at the beginning and end of the operation.Results. The average lateral displacement of the esophagus was 2.0 ±1.9 mm at the upper level, 3.4±1.6 mm at the middle level and 1.4±1.2 mm at the lower level of the left atrium. There was no significant statistically difference in the change in the position of the esophagus at the beginning and end of the operation (p=0.251, p=0.558, p=0.824, respectively, for the upper, middle and lower measurement levels). The most significant displacement of the esophageal shadow was 5.3 mm. The maximum change in the width of the contrasted lumen of the esophagus was 5.5 mm.Conclusions. According to esophagography with water-soluble contrast, the position of the esophagus during RFA PV does not experience clinically significant changes.