Key result
Esophageal position showed high stability between first and redo atrial fibrillation ablation procedures (91% ± 5% correlation) and across different imaging modalities during a single procedure.
Why the study?
Atrial fibrillation ablation carries a risk of esophageal thermal injury, but evidence regarding esophageal mobility and positional stability is inconsistent.
Is the esophageal position stable between different atrial fibrillation ablation procedures and during a single procedure as assessed by various imaging modalities?
Observational (n=135)
Is the esophageal position stable between different atrial fibrillation ablation procedures and during a single procedure as assessed by various imaging modalities?
Esophageal position remains highly stable both between separate atrial fibrillation ablation procedures and throughout a single procedure, suggesting preprocedural imaging can reliably predict intraprocedural position.
Answers are grounded in this paper and cite their sources.
May support preprocedural imaging for esophageal localization in AF ablation; leaves open prospective validation before practice change.
BackgroundAtrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent.ObjectivesThe purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure.MethodsEsophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of first pulmonary vein isolation and redo intervention (redo group) was segmented with ADAS 3D™ to compare the stability of the atrioesophageal isodistance prints. Second, 3 imaging modalities were compared for the same procedure (multimodality group): (1) preprocedural MDCT; (2) intraprocedural fluoroscopy obtained with the transesophageal echocardiographic probe in place with CARTOUNIVU™; and (3) esophageal fast anatomic map (FAM) at the end of the procedure. Esophageal position correlation between different imaging techniques was computed in MATLAB using semiautomatic segmentation analysis.ResultsThirty-five redo patients were analyzed and showed a mean atrioesophageal distance of 1.2 ± 0.6 mm and a correlation between first and redo procedure esophageal fingerprint of 91% ± 5%. Only 3 patients (8%) had a clearly different position. The multi-imaging group was composed of 100 patients. Esophageal position correlation between MDCT and CARTOUNIVU was 82% ± 10%; between MDCT and esophageal FAM was 80% ± 12%; and between esophageal FAM and CARTOUNIVU was 83% ± 15%.ConclusionThere is high stability of esophageal position between procedures and from the beginning to the end of a procedure. Further research is undergoing to test the clinical utility of the esophageal fingerprinted isodistance map to the posterior atrial wall. Atrial fibrillation ablation implies a risk of esophageal thermal injury. Esophageal position can be analyzed with imaging techniques, but evidence for esophageal mobility is inconsistent. The purpose of this study was to analyze esophageal position stability from one procedure to another and during a single procedure. Esophageal position was compared in 2 patient groups. First, preprocedural multidetector computerized tomography (MDCT) of first pulmonary vein isolation and redo intervention (redo group) was segmented with ADAS 3D™ to compare the stability of the atrioesophageal isodistance prints. Second, 3 imaging modalities were compared for the same procedure (multimodality group): (1) preprocedural MDCT; (2) intraprocedural fluoroscopy obtained with the transesophageal echocardiographic probe in place with CARTOUNIVU™; and (3) esophageal fast anatomic map (FAM) at the end of the procedure. Esophageal position correlation between different imaging techniques was computed in MATLAB using semiautomatic segmentation analysis. Thirty-five redo patients were analyzed and showed a mean atrioesophageal distance of 1.2 ± 0.6 mm and a correlation between first and redo procedure esophageal fingerprint of 91% ± 5%. Only 3 patients (8%) had a clearly different position. The multi-imaging group was composed of 100 patients. Esophageal position correlation between MDCT and CARTOUNIVU was 82% ± 10%; between MDCT and esophageal FAM was 80% ± 12%; and between esophageal FAM and CARTOUNIVU was 83% ± 15%. There is high stability of esophageal position between procedures and from the beginning to the end of a procedure. Further research is undergoing to test the clinical utility of the esophageal fingerprinted isodistance map to the posterior atrial wall.
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Terés et al. (2022) conducted an observational in Atrial fibrillation (n=135). Esophageal position imaging (MDCT, CARTOUNIVU, esophageal FAM) vs. Comparison between procedures and imaging modalities was evaluated on Esophageal position correlation between procedures and between imaging modalities. Esophageal position showed high stability between first and redo atrial fibrillation ablation procedures (91% ± 5% correlation) and across different imaging modalities during a single procedure.
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