Temporal stability of the location of the esophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter.

BACKGROUND

The esophagus may be mobile during a left atrial (LA) ablation procedure for atrial fibrillation (AF).

OBJECTIVE

The goal of the study was to determine whether the location of the esophagus is stable in patients undergoing a repeat LA ablation procedure.

METHODS

Forty-two patients underwent repeat LA ablation a mean of 7 +/- 2 months after the initial procedure. Cinefluoroscopic images of the esophagus during a barium swallow were recorded and the course of the esophagus was tagged on the 3D map. The position of the esophagus at the index and repeat procedure were compared.

RESULTS

At the index procedure, the esophagus was located near the left pulmonary veins (PVs) in 20 (48%), right PVs in 13 (31%), and at the mid LA in 9 (21%) patients. During the repeat procedure, the esophagus was found to be near the left PVs in 22 (52%), right PVs in 11 (26%), and at the mid LA in 9 patients (21%). In 35 of the 42 patients (83%), there was no change in the esophageal location, and in the remaining seven patients (17%), its position had shifted by > or =1 cm (range 1.0-4.0 cm).

CONCLUSIONS

In more than 80% of patients presenting for a repeat LA ablation procedure, the esophagus is in the same position relative to the PVs as during the initial procedure. Therefore, if radiofrequency ablation at a particular location was limited by the position of the esophagus, safe ablation at that site is unlikely to be feasible during a repeat procedure.