Relationship of the esophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation.
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Cury
Ricardo C
RC
Cardiac CT Unit, Massachusetts General Hospital-Harvard Medical School, Boston, 02114, USA.
Abbara
Suhny
S
Schmidt
Steven
S
Malchano
Zachary J
ZJ
Neuzil
Petr
P
Weichet
Jiri
J
Ferencik
Maros
M
Hoffmann
Udo
U
Ruskin
Jeremy N
JN
Brady
Thomas J
TJ
Reddy
Vivek Y
VY
D001011:Aorta / Q000033:anatomy & histology*; D001027:Aortography; D001281:Atrial Fibrillation / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation; D003287:Contrast Media; D004947:Esophagus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol