Relationship of the esophagus and aorta to the left atrium and pulmonary veins

Implications for catheter ablation of atrial fibrillation

Ricardo C. Cury, Suhny Abbara, Steven Schmidt, Zachary J. Malchano, Petr Neuzil, Jiri Weichet, Maros Ferencik, Udo Hoffmann, Jeremy N. Ruskin, Thomas J. Brady, Vivek Y. Reddy

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures. Objectives: The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA). Methods: Sixty-five subjects underwent CT imaging using a 16-slice MDCT scanner: 24 with paroxysmal AF, 21 with chronic AF, and 20 "control" subjects without a history of AF. Measurements assessed included LA diameters, width of the esophagus and aorta in contact with the posterior LA wall, and distance from the esophagus to the four pulmonary veins (PVs), spine, and LA endocardium. Results: Mean LA diameters were significantly larger in patients with AF vs the control group (P = .003 for anteroposterior diameter; P = .009 for transverse diameter). The anterior aspect of the esophagus was directly apposed to the LA in all cases (contact width 18.9 ± 4.4 mm). The position of the esophagus varied in the posterior mediastinum but on average was closer to the ostia of the left PVs (P = .0001). The descending aorta was in contact with the LA and/or left PVs in 50 of 65 subjects. The esophagus was closer to the spine in the chronic AF vs control group (P = .007), likely due to increased LA dimension. Conclusion: In addition to its ability to assess PV anatomy, preprocedural MDCT imaging can investigate the variable relationship of adjacent structures, such as the esophagus and aorta to the LA and PVs.

Original languageEnglish (US)
Pages (from-to)1317-1323
Number of pages7
JournalHeart Rhythm
Volume2
Issue number12
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Catheter Ablation
Pulmonary Veins
Heart Atria
Atrial Fibrillation
Esophagus
Aorta
Multidetector Computed Tomography
Spine
Esophageal Fistula
Endocardium
Control Groups
Mediastinum
Thoracic Aorta
Anatomy
Catheters

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Complications
  • Esophagus
  • Multidetector computed tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relationship of the esophagus and aorta to the left atrium and pulmonary veins : Implications for catheter ablation of atrial fibrillation. / Cury, Ricardo C.; Abbara, Suhny; Schmidt, Steven; Malchano, Zachary J.; Neuzil, Petr; Weichet, Jiri; Ferencik, Maros; Hoffmann, Udo; Ruskin, Jeremy N.; Brady, Thomas J.; Reddy, Vivek Y.

In: Heart Rhythm, Vol. 2, No. 12, 12.2005, p. 1317-1323.

Research output: Contribution to journalArticle

Cury, RC, Abbara, S, Schmidt, S, Malchano, ZJ, Neuzil, P, Weichet, J, Ferencik, M, Hoffmann, U, Ruskin, JN, Brady, TJ & Reddy, VY 2005, 'Relationship of the esophagus and aorta to the left atrium and pulmonary veins: Implications for catheter ablation of atrial fibrillation', Heart Rhythm, vol. 2, no. 12, pp. 1317-1323. https://doi.org/10.1016/j.hrthm.2005.09.012
Cury, Ricardo C. ; Abbara, Suhny ; Schmidt, Steven ; Malchano, Zachary J. ; Neuzil, Petr ; Weichet, Jiri ; Ferencik, Maros ; Hoffmann, Udo ; Ruskin, Jeremy N. ; Brady, Thomas J. ; Reddy, Vivek Y. / Relationship of the esophagus and aorta to the left atrium and pulmonary veins : Implications for catheter ablation of atrial fibrillation. In: Heart Rhythm. 2005 ; Vol. 2, No. 12. pp. 1317-1323.
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T1 - Relationship of the esophagus and aorta to the left atrium and pulmonary veins

T2 - Implications for catheter ablation of atrial fibrillation

AU - Cury, Ricardo C.

AU - Abbara, Suhny

AU - Schmidt, Steven

AU - Malchano, Zachary J.

AU - Neuzil, Petr

AU - Weichet, Jiri

AU - Ferencik, Maros

AU - Hoffmann, Udo

AU - Ruskin, Jeremy N.

AU - Brady, Thomas J.

AU - Reddy, Vivek Y.

PY - 2005/12

Y1 - 2005/12

N2 - Background: A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures. Objectives: The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA). Methods: Sixty-five subjects underwent CT imaging using a 16-slice MDCT scanner: 24 with paroxysmal AF, 21 with chronic AF, and 20 "control" subjects without a history of AF. Measurements assessed included LA diameters, width of the esophagus and aorta in contact with the posterior LA wall, and distance from the esophagus to the four pulmonary veins (PVs), spine, and LA endocardium. Results: Mean LA diameters were significantly larger in patients with AF vs the control group (P = .003 for anteroposterior diameter; P = .009 for transverse diameter). The anterior aspect of the esophagus was directly apposed to the LA in all cases (contact width 18.9 ± 4.4 mm). The position of the esophagus varied in the posterior mediastinum but on average was closer to the ostia of the left PVs (P = .0001). The descending aorta was in contact with the LA and/or left PVs in 50 of 65 subjects. The esophagus was closer to the spine in the chronic AF vs control group (P = .007), likely due to increased LA dimension. Conclusion: In addition to its ability to assess PV anatomy, preprocedural MDCT imaging can investigate the variable relationship of adjacent structures, such as the esophagus and aorta to the LA and PVs.

AB - Background: A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures. Objectives: The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA). Methods: Sixty-five subjects underwent CT imaging using a 16-slice MDCT scanner: 24 with paroxysmal AF, 21 with chronic AF, and 20 "control" subjects without a history of AF. Measurements assessed included LA diameters, width of the esophagus and aorta in contact with the posterior LA wall, and distance from the esophagus to the four pulmonary veins (PVs), spine, and LA endocardium. Results: Mean LA diameters were significantly larger in patients with AF vs the control group (P = .003 for anteroposterior diameter; P = .009 for transverse diameter). The anterior aspect of the esophagus was directly apposed to the LA in all cases (contact width 18.9 ± 4.4 mm). The position of the esophagus varied in the posterior mediastinum but on average was closer to the ostia of the left PVs (P = .0001). The descending aorta was in contact with the LA and/or left PVs in 50 of 65 subjects. The esophagus was closer to the spine in the chronic AF vs control group (P = .007), likely due to increased LA dimension. Conclusion: In addition to its ability to assess PV anatomy, preprocedural MDCT imaging can investigate the variable relationship of adjacent structures, such as the esophagus and aorta to the LA and PVs.

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KW - Catheter ablation

KW - Complications

KW - Esophagus

KW - Multidetector computed tomography

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