title: Complex anatomy surrounding the left atrial posterior wall: analysis with 3D computed tomography.
abstract: Few studies have explored the topographic anatomy of the esophagus, posterior wall of the left atrium (LA), or fat pads using multidetector computed tomography (MDCT) to prevent the risk of esophageal injury during atrial fibrillation (AF) ablation. MDCT was performed in 110 consecutive patients with paroxysmal or persistent AF before the ablation procedure to understand the anatomic relationship of the esophagus. Two major types of esophagus routes were demonstrated. Leftward (type A) and rightward (type B) routes were found in 90 and 10% of the patients, respectively. A type A route had a larger mean size of the LA than type B. The fat pad was identifiable at the level of the inferior pulmonary vein in 91% of the patients without any predominance of either type. The thickness of the fat pad was thinner in the patients with a dilated LA (>42 mm) than in those with a normal LA size (≤42 mm) (p = 0.01). The results demonstrated that the majority of cases had a leftward route of the esophagus. There was a close association between the LA dilatation and fat pad thinning. With a dilated LA, the esophagus may become easily susceptible to direct thermal injury during AF ablation. Visualization of the anatomic relationship may contribute to the prevention of the potential risk of an esophageal injury.
authors.affiliation: Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan. s-maeda@ja2.so-net.ne.jp
authors.forename: Shingo
authors.initials: S
authors.lastname: Maeda
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Kikuya
authors.initials: K
authors.lastname: Uno
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Otomo
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Nagata
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Masahiko
authors.initials: M
authors.lastname: Goya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Hideomi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D018570:Risk Assessment; D012307:Risk Factors; D036542:Tomography, Spiral Computed