title: Initial experience of assessing esophageal tissue injury and recovery using delayed-enhancement MRI after atrial fibrillation ablation.
abstract: 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.
authors.affiliation: Comprehensive Arrhythmia and Research Management, University of Utah School of Medicine, Salt Lake City, UT 84132-2400, USA.
authors.forename: Troy J
authors.initials: TJ
authors.lastname: Badger
authors.forename: Yaw A
authors.initials: YA
authors.lastname: Adjei-Poku
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Burgon
authors.forename: Saul
authors.initials: S
authors.lastname: Kalvaitis
authors.forename: Akram
authors.initials: A
authors.lastname: Shaaban
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Sommers
authors.forename: Joshua J E
authors.initials: JJ
authors.lastname: Blauer
authors.forename: Eric N
authors.initials: EN
authors.lastname: Fish
authors.forename: Nazem
authors.initials: N
authors.lastname: Akoum
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Haslem
authors.forename: Eugene G
authors.initials: EG
authors.lastname: Kholmovski
authors.forename: Rob S
authors.initials: RS
authors.lastname: MacLeod
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
mesh_terms: 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
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine