Movement of the esophagus during left atrial catheter ablation for atrial fibrillation

OBJECTIVES The aim of this study was to describe the extent of esophageal mobility that occurs during catheter ablation for atrial fibrillation under conscious sedation. BACKGROUND Ablation along the posterior left atrium may cause an atrioesophageal fistula. One strategy for avoiding this risk is to not deliver radiofrequency energy at sites in contact with the esophagus. METHODS In 51 consecutive patients with atrial fibrillation who underwent left atrial ablation, under conscious sedation, digital cine-fluoroscopic imaging of the esophagus was performed in two views after ingestion of barium paste at the beginning and end of the ablation procedure. Movement of the esophagus was determined at the superior, mid-, and inferior parts of the posterior left atrium in reference to the spine. RESULTS Mean esophageal movement was 2.0 +/- 0.8 cm (range = 0.3 to 3.8 cm) at the superior, 1.7 +/- 0.8 cm (range = 0.1 to 3.5 cm) at the mid-, and 2.1 +/- 1.2 cm (range = 0.1 to 4.5 cm) at the inferior levels. In 67% of the 51 patients, the esophagus shifted by 2 cm, and in 4% there was :4 cm of lateral movement. The mean change in esophageal luminal width was 5 +/- 7 mm (range = 0 to 36 mm) at the superior, 5 +/- 7 min (range = 0 to 32 mm) at the mid-, and 6 +/- 7 mm (range = 0 to 21 mm) at the inferior levels of the posterior left atrium. CONCLUSIONS The esophagus often is mobile and shifts sideways by >= 2 cm in a majority of patients undergoing catheter ablation for atrial fibrillation under conscious sedation. Therefore, real-time imaging of the esophagus may be helpful in reducing the risk of esophageal injury during radiofrequency ablation along the posterior left atrium.