Use of oral gadobenate dimeglumine to visualise the oesophagus during magnetic resonance angiography in patients with atrial fibrillation prior to catheter ablation

Abstract

BackgroundAtrio-oesophageal fistula was first reported as a fatal complication of surgical endocardial and percutaneous endocardial radiofrequency ablation for atrial fibrillation, with an incidence after catheter ablation between 0.03% and 0.5%. Magnetic resonance angiography (MRA) was usually performed to obtain pre-procedural 3D images, used to merging into an electro-anatomical map, guiding step-by-step ablation strategy of AF. Our aim was to find an easy, safe and cost-effective way to enhance the oesophagus during MRA.MethodsIn 105 consecutive patients, a right-left phase encoding, free breathing, 3D T1 MRA sequence was performed in the axial plane, >24 hours before catheter ablation, using an intravenous injection of gadobenate dimeglumine contrast medium. The oesophagus was enhanced using an oral gel solution of 0.7 mL gadobenate dimeglumine contrast medium mixed with approximately 40 mg thickened water gel, which was swallowed by the patients on the scanning table, immediately before the MRA sequence acquisition.ResultsThe visualisation of the oesophagus was obtained in 104/105 patients and images were successfully merged, as left atrium and pulmonary veins, into an electro-anatomical map, during percutaneous endocardial radiofrequency ablation. All patients tolerated the study protocol and no immediate or late complication was observed with the oral contrast agent administration. The free-breathing MRA sequence used in our protocol took 7 seconds longer than MRA breath-hold conventional sequence.ConclusionOesophagus visualization with oral gadobenate dimeglumine is feasible for integration of oesophagus anatomy images into the electro-anatomical map during AF ablation, without undesirable side effects and without significantly increasing cost or examination time.

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

“…To date no randomized study has ruled out this point, and even without the use of pre-procedural imaging high acute and long-term success rate using the cryoballoon therapy was reported. In the meantime, although with the nMARQ TM catheter we demonstrated no impact of PV anatomy on acute and mid-term outcome, preablation imaging however allowed a reduction in the fluoroscopy time [10] and, in case of MR, holds the potential to reduce esophageus-related complications by directly localizing its anatomical relationships with the LA and guiding selective ablation power reductions [25].…”

The dream of near-zero X-rays ablation comes true

“…Eventually the systematic use of electroanatomic mapping systems integrated with preacquired imaging, in this case cardiac magnetic resonance with use of oral gadobenate dimeglumine, 47 also presents the advantage of visualizing the esophagus in relation to points of radiofrequency delivery. This anatomical correlation indeed holds the potential to limit atrioesophageal fistulas, a rare but potentially fatal periprocedural complication of percutaneous AF ablation.…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…The varia section contains papers of interest that do not easily fall into a larger well described category, and includes valve disease, [194] ventricular function, [195–198] mass, [199] and shape, [200] pericardium, [201] position papers, [202] safety papers, [203] summary papers, [204] reviews, [205] and errata [206, 207]. …”