title: Retro-cardiac esophageal mobility and deflection to prevent thermal injury during atrial fibrillation ablation: an anatomic feasibility study.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation often causes minor esophageal (ESO) injury, and sometimes lethal posterior left atria (PLA)-ESO fistula. Avoidance techniques (energy reduction and/or complete target avoidance) provide questionable ESO protective value, and are likely associated with increased AF recurrence.
  
  
  RESULTS
  Potential independent mobility, deflectability and age-related anatomic factors, assessed by multi-position, and age-progressive thoracic computed tomography scans, show (1) mobility of the retro-cardiac ESO-PLA juxtaposition, (2) age-related increased thermal ablation vulnerability; and also, age-increased potential for retro-cardiac ESO mobility and deflectability to avoid collateral injury; and that (3) the retro-cardiac vertebral bodies and the descending aorta create a patient-specific esophageal corridor which defines the resting supine esophageal position and the subsequent PLA-ESO crossing points.
  
  
  CONCLUSIONS
  A small, 1-3 mm, increase in separation of the ESO relative to the PLA occurs when moving the patient from supine to lateral and from supine to prone position. Because of the concave spine; the PLA-ESO area of apposition increases. Patient rotation of 90° and 180° does not create enough passive PLA-ESO separation to avoid collateral ESO thermal energy; but, active repositioning lateral and out of ESO corridor appears feasible.
authors.affiliation: The University of Toledo, Toledo, OH, USA.
authors.forename: Khalil
authors.initials: K
authors.lastname: Kanjwal
authors.forename: Richard
authors.initials: R
authors.lastname: Yeasting
authors.forename: James D
authors.initials: JD
authors.lastname: Maloney
authors.forename: Carlos
authors.initials: C
authors.lastname: Baptista
authors.forename: Haitham
authors.initials: H
authors.lastname: Elsamaloty
authors.forename: Mujeeb
authors.initials: M
authors.lastname: Sheikh
authors.forename: Mohammad
authors.initials: M
authors.lastname: Elahinia
authors.forename: Walter
authors.initials: W
authors.lastname: Anderson
authors.forename: James D
authors.initials: JD
authors.lastname: Maloney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D002058:Burns, Electric / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult