title: Use of oral gadobenate dimeglumine to visualise the oesophagus during magnetic resonance angiography in patients with atrial fibrillation prior to catheter ablation.
abstract: BACKGROUND
  Atrio-oesophageal fistula was first reported as a fatal complication of surgical endocardial and percutaneous endocardial radiofrequency ablation for atrial fibrillation, with an incidence after catheter ablation between 0.03% and 0.5%. Magnetic resonance angiography (MRA) was usually performed to obtain pre-procedural 3D images, used to merging into an electro-anatomical map, guiding step-by-step ablation strategy of AF. Our aim was to find an easy, safe and cost-effective way to enhance the oesophagus during MRA.
  
  
  METHODS
  In 105 consecutive patients, a right-left phase encoding, free breathing, 3D T1 MRA sequence was performed in the axial plane, >24 hours before catheter ablation, using an intravenous injection of gadobenate dimeglumine contrast medium. The oesophagus was enhanced using an oral gel solution of 0.7 mL gadobenate dimeglumine contrast medium mixed with approximately 40 mg thickened water gel, which was swallowed by the patients on the scanning table, immediately before the MRA sequence acquisition.
  
  
  RESULTS
  The visualisation of the oesophagus was obtained in 104/105 patients and images were successfully merged, as left atrium and pulmonary veins, into an electro-anatomical map, during percutaneous endocardial radiofrequency ablation. All patients tolerated the study protocol and no immediate or late complication was observed with the oral contrast agent administration. The free-breathing MRA sequence used in our protocol took 7 seconds longer than MRA breath-hold conventional sequence.
  
  
  CONCLUSIONS
  Oesophagus visualization with oral gadobenate dimeglumine is feasible for integration of oesophagus anatomy images into the electro-anatomical map during AF ablation, without undesirable side effects and without significantly increasing cost or examination time.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Faletti
authors.affiliation: Istituto di Radiologia dell'Università degli Studi di Torino, A,O, Città della Salute e della Scienza, Via Genova 3, 10126 Torino, Italy. alessandro.rapellino@fastwebnet.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rapellino
authors.forename: Francesca
authors.initials: F
authors.lastname: Barisone
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Federico
authors.initials: F
authors.lastname: Ferraris
authors.forename: Paolo
authors.initials: P
authors.lastname: Fonio
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gandini
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003287:Contrast Media / Q000008:administration & dosage*; D004937:Esophageal Fistula / Q000209:etiology / Q000517:prevention & control; D004947:Esophagus / Q000033:anatomy & histology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D018810:Magnetic Resonance Angiography; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine