Late gadolinium enhancement of the esophagus is common on cardiac MR several months after pulmonary vein isolation: preliminary observations.
BACKGROUND
Pulmonary vein isolation (PVI) as a treatment for atrial fibrillation (AF) is commonly performed. This procedure can damage the esophagus. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) offers noninvasive assessment of scar. We sought to examine the prevalence of esophageal hyperenhancement on LGE-CMR prior to and following PVI.


METHODS
Seventy-four patients underwent LGE-CMR prior to and 1.7 +/- 1.9 months post PVI for AF. Transmural esophageal hyperenhancement was visually assessed. The pre- and post PVI esophageal position was measured, relative to the vertebral body.


RESULTS
Prior to PVI, 3% (2/74) of patients had esophageal LGE on CMR. At post-PVI follow-up, 30% (23/74) of the studies demonstrated new esophageal hyperenhancement adjacent to an ablation site. Most (74%, 17/27) positive esophageal LGE studies were performed >30 days after PVI, while no (0/9) studies performed >2 months post PVI were positive for esophageal hyperenhancement. The presence of post-procedural esophageal hyperenhancement was not associated with longer ablation time (P = 0.42), use of an irrigated catheter (74% with LGE vs 47% without, P = 0.16), right-sided esophageal location (56% with LGE vs 39% without, P = 0.17), size of left atrium cavity (58 +/- 8 mm with LGE vs 61 +/- 10 mm without, P = 0.15), or the timing of the LGE-CMR study after PVI (36 +/- 10 days with LGE vs 60 +/- 66 days without, P = 0.09).


CONCLUSIONS
Though rare before PVI, new esophageal LGE is seen in almost one-third of patients after PVI. The clinical implications to remain to be explored, but clinicians should be aware of this frequent imaging finding.
Meng
Joyce
J
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
Peters
Dana C
DC
Hsing
Jeffrey M
JM
Chuang
Michael L
ML
Chan
Jonathan
J
Fish
Airley
A
Josephson
Mark E
ME
Manning
Warren J
WJ
D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D002921:Cicatrix / Q000175:diagnosis*; D003287:Contrast Media; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D003287:Contrast Media; D005682:Gadolinium