Sandhu Amneet, Zipse Matthew M, Borne Ryan T, Aleong Ryan G, Tompkins Christine, Schuller Joseph, Rosenberg Michael, Varosy Paul D, Tzou Wendy S, Nguyen Duy T, Sauer William H
Section of Electrophysiology, The University of Colorado, Aurora, Colorado.
Section of Electrophysiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
Pacing Clin Electrophysiol. 2019 Apr;42(4):458-463. doi: 10.1111/pace.13639. Epub 2019 Feb 28.
Despite improvement in catheter ablation for atrial fibrillation (AF), ability to recognize and prevent esophageal injury remains challenging. We hypothesized that esophageal course may impact esophageal heating, as measured through ablation, and thereby, risk of injury.
We evaluated all patients undergoing first-time AF ablation with preprocedural computed tomography (CT) imaging from 2014 to 2016 at our institution, focusing on esophageal position at the left atrial (LA)/pulmonary vein junction. Esophageal luminal temperatures (ELTs) were analyzed by esophageal course. In exploratory work by investigation of published reports of atrioesophageal fistula (AEF), we evaluated for a relationship between esophageal course and risk of AEF.
Of 68 patients, 48.5% had midline, 36.8% leftward, and 14.7% rightward esophageal positions. Of 20 patients (29% of cohort) with esophageal confinement-defined as a midline or leftward position relative to the LA, vertebrae, and aorta, with luminal distortion-14 had leftward position. No significant differences in patient or procedure characteristics were noted between confinement and nonconfinement cohorts. The average peak ELT was significantly higher in those with confinement (36.9°C vs 36.2°C, P < 0.05) and confinement with a left-sided esophagus (37.1°C vs 36.2°C, P < 0.05). There was a significant correlation between esophageal confinement and risk of AEF (odds ratio [OR]: 2.7, 95% confidence interval [CI]: 1.2-6.2, P < 0.01).
Approximately one-third of patients undergoing AF ablation display leftward esophageal course along the ablation zone on preprocedure CT imaging, with a significant portion exhibiting esophageal confinement. In those with confinement, higher peak ELTs are noted with ablation. Esophageal confinement may be a risk factor for development of AEF.
尽管心房颤动（AF）导管消融技术有所改进，但识别和预防食管损伤的能力仍然具有挑战性。我们推测食管走行可能会影响通过消融测量的食管加热情况，进而影响损伤风险。
我们评估了2014年至2016年在我院接受首次AF消融且术前行计算机断层扫描（CT）成像的所有患者，重点关注食管在左心房（LA）/肺静脉交界处的位置。根据食管走行分析食管腔内温度（ELTs）。在对已发表的房室食管瘘（AEF）报告进行调查的探索性研究中，我们评估了食管走行与AEF风险之间的关系。
68例患者中，48.5%食管位于中线，36.8%向左，14.7%向右。20例患者（占队列的29%）食管受限，定义为相对于LA、椎体和主动脉处于中线或左侧位置且管腔变形，其中14例向左。受限组和非受限组在患者或手术特征方面未发现显著差异。受限组的平均峰值ELT显著更高（36.9°C对36.2°C，P<0.05），左侧食管受限组更高（37.1°C对36.2°C，P<0.05）。食管受限与AEF风险之间存在显著相关性（优势比[OR]：2.7，95%置信区间[CI]：1.2 - 6.2，P<0.01）。
在术前行CT成像时，约三分之一接受AF消融的患者在消融区域沿食管走行向左，且有相当一部分显示食管受限。在受限患者中，消融时峰值ELT更高。食管受限可能是AEF发生的危险因素。
