title: Esophageal contour changes during cryoablation of atrial fibrillation.
abstract: BACKGROUND
  We have observed contour changes of the barium-filled esophagus during atrial fibrillation (AF) ablation with cryo-energy delivered in direct proximity to the esophagus.
  
  
  OBJECTIVE
  To evaluate the frequency, location, and severity of esophageal contour changes during cryo-energy application close to the esophagus.
  
  
  METHODS
  We retrospectively analyzed cine-fluoroscopic images acquired during hybrid cryo-radiofrequency AF ablation in 100 consecutive patients with cryo-energy delivered only in direct proximity to the esophagus.
  
  
  RESULTS
  Esophageal contour changes were observed in 28 (32%) of 89 patients (and 74 [6.2%] of 1,191 of all cryo applications). They were more frequent in the left common pulmonary vein (PV) (50%) and less so in the right common PV and the upper PVs (4-5%). The distance of the ablation catheter from the endoesophageal contour prior to cryo-energy applications associated with contour changes was 1.8 +/- 1.5 mm, which increased to 4.1 +/- 1.6 mm at the time of peak contour change (P < 0.001). The esophageal contour deformation was 2.3 +/- 0.9 mm. There were no apparent complications related to cryo-energy application for 3-4 minutes, even if associated with contour changes.
  
  
  CONCLUSIONS
  Esophageal contour changes were observed in >6% of cryo applications in direct proximity to the esophagus (32% of patients) and were most frequent in the posterior aspect of the left common and right lower PV ostium when cryo-energy was delivered at a distance of <or=5 mm from the esophageal contrast silhouette. No overt esophageal injury occurred. However, the safety of cryo-energy application in direct proximity to the esophagus remains to be further confirmed.
authors: Division of Cardiology, Tampa General Hospital and University of South Florida, Tampa, FL 33606, USA. bherweg@tampabay.rr.com
authors: Bengt
authors: B
authors: Herweg
authors: Rias
authors: R
authors: Ali
authors: Nadim
authors: N
authors: Khan
authors: Arzu
authors: A
authors: Ilercil
authors: S S
authors: SS
authors: Barold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome