title: Movement of the esophagus during left atrial catheter ablation for atrial fibrillation.
abstract: OBJECTIVE
  The aim of this study was to describe the extent of esophageal mobility that occurs during catheter ablation for atrial fibrillation under conscious sedation.
  
  
  BACKGROUND
  Ablation along the posterior left atrium may cause an atrioesophageal fistula. One strategy for avoiding this risk is to not deliver radiofrequency energy at sites in contact with the esophagus.
  
  
  METHODS
  In 51 consecutive patients with atrial fibrillation who underwent left atrial ablation under conscious sedation, digital cine-fluoroscopic imaging of the esophagus was performed in two views after ingestion of barium paste at the beginning and end of the ablation procedure. Movement of the esophagus was determined at the superior, mid-, and inferior parts of the posterior left atrium in reference to the spine.
  
  
  RESULTS
  Mean esophageal movement was 2.0 +/- 0.8 cm (range = 0.3 to 3.8 cm) at the superior, 1.7 +/- 0.8 cm (range = 0.1 to 3.5 cm) at the mid-, and 2.1 +/- 1.2 cm (range = 0.1 to 4.5 cm) at the inferior levels. In 67% of the 51 patients, the esophagus shifted by > or =2 cm, and in 4% there was > or =4 cm of lateral movement. The mean change in esophageal luminal width was 5 +/- 7 mm (range = 0 to 36 mm) at the superior, 5 +/- 7 mm (range = 0 to 32 mm) at the mid-, and 6 +/- 7 mm (range = 0 to 21 mm) at the inferior levels of the posterior left atrium.
  
  
  CONCLUSIONS
  The esophagus often is mobile and shifts sideways by > or=2 cm in a majority of patients undergoing catheter ablation for atrial fibrillation under conscious sedation. Therefore, real-time imaging of the esophagus may be helpful in reducing the risk of esophageal injury during radiofrequency ablation along the posterior left atrium.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Kristina
authors.initials: K
authors.lastname: Lemola
authors.forename: Jihn
authors.initials: J
authors.lastname: Han
authors.forename: Kamala
authors.initials: K
authors.lastname: Tamirisa
authors.forename: Petar
authors.initials: P
authors.lastname: Igic
authors.forename: Darryl
authors.initials: D
authors.lastname: Elmouchi
authors.forename: David
authors.initials: D
authors.lastname: Tschopp
authors.forename: Scott
authors.initials: S
authors.lastname: Reich
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016292:Procedural Sedation; D004937:Esophageal Fistula / Q000209:etiology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005402:Fistula / Q000209:etiology; D005471:Fluoroscopy; D006325:Heart Atria; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement