title: Esophageal tissue injury following pulmonary vein isolation using the PVAC: assessment by endoscopy and magnetic resonance imaging.
abstract: BACKGROUND
  We investigate the frequency of esophageal tissue injury (ETI) following ablation of atrial fibrillation (AF) using the pulmonary vein ablation catheter (PVAC) ascertained by esophageal endoscopy (ESE) and corresponding magnetic resonance imaging (MRI).
  
  
  METHODS
  A total of 41 patients with symptomatic AF presenting for pulmonary vein isolation (PVI) were included consecutively in two observational groups. Group A received MRI the day before and ESE plus MRI within 3-4 weeks following the ablation procedure using the PVAC. Group B received MRI the day before and ESE plus MRI within 2 days after PVI. MRI included T2-weighted and T1-weighted postcontrast with fat suppression (fs) and late-enhancement scans to demonstrate postprocedural edema and contrast enhancement of the esophageal wall.
  
  
  RESULTS
  A total of 13 (32%) patients were enrolled in Group A (26 ± 11 days post-PVI), and 28 (68%) patients in Group B (2 ± 0.6 days post-PVI). ETI was found by ESE in one (2%) patient (Group B) and resolved under conservative therapy. Corresponding MRI showed a false negative result with no alterations of esophageal structures using T1-weighted, T2-weighted, and late enhancement scans. In addition, false positive results were demonstrated by late-enhancement MRI in five (12%) patients (three patients in Group A and two patients in Group B), which could not be verified by corresponding ESE.
  
  
  CONCLUSIONS
  Endoluminal ETI is a rare but possible complication, which should be considered following PVAC procedures. MRI of the esophagus is currently not a reliable screening method due to false positive and negative findings compared to ESE.
authors: Klinik und Poliklinik für Innere Medizin II, University Medical Center Regensburg, Regensburg, Germany. christian.vonbary@swmbrk.de
authors: Christian
authors: C
authors: von Bary
authors: Christian
authors: C
authors: Dornia
authors: Gabriele
authors: G
authors: Kirchner
authors: Stefan
authors: S
authors: Weber
authors: Claudia
authors: C
authors: Fellner
authors: David
authors: D
authors: Nisenbaum
authors: Martina
authors: M
authors: Georgieva
authors: Christian
authors: C
authors: Stroszczynski
authors: Okka W
authors: OW
authors: Hamer
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003287:Contrast Media; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol