Avoiding oesophageal injury during cardiac ablation: insights gained from mediastinal anatomy.

AIMS

This study investigates the lateral displacement of the oesophagus at the level of the left atrium (LA) in 11 cadavers.

METHODS AND RESULTS

The study was conducted using human cadavers. An endotracheal stylet probe was inserted into the eosphagus. The pericardium overlying the posterior LA was fixed in place. The lateral movement of the oesophagus from side to side was recorded. The initial study method had the stylet probe extending to the gastroesophageal (GE) junction. A revised protocol had the distal end of the endotracheal stylet probe ∼4 cm cranial to the GE junction. In six cadavers using the initial study method, the oesophagus was displaced a mean of 1.8 ± 0.35 cm to the right and 2 ± 0.48 cm to the left. In five cadavers, using the revised method, the oesophagus was displaced by a mean of 2.26 ± 0.27 cm to the right and 2.3 ± 0.66 cm to the left.

CONCLUSION

Mediastinal anatomy, specifically the presence of a loose connective tissue that attaches the oesophagus to the parietal pericardium overlying the posterior LA wall will allow for a lateral displacement of the oesophagus. This should decrease or eliminate the likelihood of thermal injury of the oesophagus. Using an endotracheal stylet, we investigated the lateral displacement of the oesophagus in 11 human cadavers. In six with the stylet extending to the GE junction, the oesophagus was displaced a mean of 3.8 cm. In five, with stylet 4 cm cranial to the junction, the displacement was 4.56 cm.