Initial experience of assessing esophageal tissue injury and recovery using delayed-enhancement MRI after atrial fibrillation ablation.
BACKGROUND
Esophageal wall thermal injury after atrial fibrillation ablation is a potentially serious complication. However, no noninvasive modality has been used to describe and screen patients to examine whether esophageal wall injury has occurred. We describe a noninvasive method of using delayed-enhancement MRI to detect esophageal wall injury and subsequent recovery after atrial fibrillation ablation.


RESULTS
We analyzed the delayed-enhancement MRI scans of 41 patients before ablation and at 24 hours and 3 months after ablation to determine whether there was evidence of contrast enhancement in the esophagus after atrial fibrillation ablation. In patients with contrast enhancement, 3D segmentation of the esophagus was performed using a novel image processing method. Upper gastrointestinal endoscopy was then performed. Repeat delayed-enhancement MRI and upper gastrointestinal endoscopy was performed 1 week later to track changes in lesions. The wall thickness of the anterior and posterior wall of the esophagus was measured at 3 time points: before ablation, 24 hours after ablation, and 3 months after ablation. Evaluation of preablation MRI scans demonstrated no cases of esophageal enhancement. At 24 hours, 5 patients showed contrast enhancement. Three of these patients underwent upper gastrointestinal endoscopy, which demonstrated esophageal lesions. Repeat upper gastrointestinal endoscopy and MRI 1 week later demonstrated resolution of the lesions. All 5 patients had confirmed resolution of enhancement at 3 months. All patients with esophageal tissue enhancement demonstrated left atrial wall enhancement directly adjacent to the regions of anterior wall esophageal enhancement.


CONCLUSIONS
Our preliminary results indicate delayed-enhancement MRI can assess the extent and follow progression of esophageal wall injury after catheter ablation of atrial fibrillation. It appears that acute esophageal injury recovers within 1 week of the procedure.
Badger
Troy J
TJ
Comprehensive Arrhythmia and Research Management, University of Utah School of Medicine, Salt Lake City, UT 84132-2400, USA.
Adjei-Poku
Yaw A
YA
Burgon
Nathan S
NS
Kalvaitis
Saul
S
Shaaban
Akram
A
Sommers
Daniel N
DN
Blauer
Joshua J E
JJ
Fish
Eric N
EN
Akoum
Nazem
N
Haslem
Thomas S
TS
Kholmovski
Eugene G
EG
MacLeod
Rob S
RS
Adler
Douglas G
DG
Marrouche
Nassir F
NF
D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003287:Contrast Media; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors
D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine