Anatomic proximity of the esophagus to the coronary sinus: implication for catheter ablation within the coronary sinus.
BACKGROUND
The anatomic proximity between the esophagus and the coronary sinus (CS) might render the esophagus vulnerable to thermal injury during ablation. Therefore, we investigated the anatomic relationship between the esophagus and the CS in patients with atrial fibrillation (AF).


RESULTS
Thirty patients (25 males, mean age = 54 +/- 11 years) with drug-refractory paroxysmal AF were included. Sixteen-slice multidetector computed tomography was performed to depict the course of the esophagus and relationship to the CS. The esophagus was in direct contact with the CS in 57% (17/30) of patients (group 1). The mean length of the contact was 6.1 +/- 3.4 mm. In the remaining 13 patients, the esophagus did not come in direct contact with the CS (group 2). The shortest distance between the esophagus and the CS was 4.0 +/- 2.6 mm. The CS diameter (9.4 +/- 1.8 vs 8.5 +/- 2.4 mm, P = 0.15), esophagus width (18.6 +/- 1.6 vs 18.6 +/- 1.7 mm, P = 0.87), anteroposterior diameter of the left atrium (35.9 +/- 3.8 vs 35.0 +/- 3.3 mm, P = 0.58), thickness of the anterior wall of the esophagus (2.9 +/- 0.6 vs 2.9 +/- 0.6 mm, P = 0.97), and shortest distance from the esophagus to the CS ostium (19.3 +/- 5.4 vs 25.0 +/- 6.2 mm, P = 0.02) and to the great cardiac vein (8.5 +/- 5.3 vs 12.1 +/- 6.9 mm, P = 0.10) were compared between the two groups.


CONCLUSIONS
In 57% of our patients, the esophagus was in direct contact with the CS, and a significantly shorter distance between the esophagus and the CS ostium was noted in these patients. It is important to prevent esophageal damage when applying energy within the CS.
Tsao
Hsuan-Ming
HM
I-Lan Hospital, Taiwan.
Wu
Mei-Han
MH
Chern
Ming-Sheng
MS
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Chang
Shih-Lin
SL
Chiang
Shuo-Ju
SJ
Ong
Mary Gertrude
MG
Wongcharoen
Wanwarang
W
Hsu
Nai-Wei
NW
Chang
Cheng-Yen
CY
Chen
Shih-Ann
SA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D004947:Esophagus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D006321:Heart / Q000033:anatomy & histology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed