Abstract 11544: Esophagographic Quantification of the Amount of Esophageal Mechanical Displacement During Atrial Fibrillation Ablation

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A11544
• Main Authors: Gianni, Carola, Chen, Qiong, Gedikli, Ömer, MacDonald, Bryan C, Della Rocca, Domenico G, Trivedi, Chintan, Mohanty, Sanghamitra, Al-Ahmad, Amin, Burkhardt, J D, Gallinghouse, G J, Hranitzky, Patrick M, Horton, Rodney P, Di Biase, Luigi, Sanchez, Javier E, Natale, Andrea
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

IntroductionMechanical esophageal displacement (ED) is one of the strategies to prevent esophageal injury. However, given the presence of anchoring ligaments to the surrounding structures (trachea, aorta, pleura, and diaphragm), assuming adequate displacement without proper visualization can be misleading.HypothesisThe amount of ED using a commercially available nitinol stylet (EsoSure) might be overestimated without real time visualization of the esophagus.Methods13 patients undergoing atrial fibrillation ablation and in which the esophagus was displaced with the EsoSure device were included in the study. Water soluble oral contrast (diatrizoate meglumine/sodium, GastroGrafin) was injected to delineate the esophageal course throughout the procedure. The amount of ED was quantified averaging two measurements obtained using the left border of the spine as reference.ResultsThe esophagus was located in the mid-left atrium in 7 (54%), towards the left pulmonary veins in 2 (15%) and towards the right pulmonary veins in 4 (31%). Overall, ED in at least one direction was possible in 11/13 patients (85%; Figure). Deviation towards the left-sided pulmonary veins was attempted in 11/13 patients, and successful in 8/11 (73%). The mean leftward deviation was 1.7 cm (range 0.3-3.5 cm); in 1/8 (9%), ED was < 0.5 cm. Deviation towards the right-sided pulmonary veins was attempted in 12/13 patients, and successful in 6/12 (50%). The mean rightward deviation was 0.6 cm (range 0.1-1.1 cm); in 3/6 (50%), ED was < 0.5 cm.Conclusionst’s important to perform esophagography when attempting mechanical ED, as it is not uncommon to observe little to no esophageal deviation. Of note, rightward deviation appears to be more challenging, where inadequate displacement is observed in up to ¾ of patients.