Relationship of the esophagus and aorta to the left atrium and pulmonary veins: Implications for catheter ablation of atrial fibrillation

Cury, Ricardo C.; Abbara, Suhny; Schmidt, Steven; Malchano, Zachary J.; Neuzil, Petr; Weichet, Jiri; Ferencik, Maros; Hoffmann, Udo; Ruskin, Jeremy N.; Brady, Thomas J.; Reddy, Vivek Y.

doi:10.1016/j.hrthm.2005.09.012

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Volume 2, Issue 12 , Pages 1317-1323, December 2005

Relationship of the esophagus and aorta to the left atrium and pulmonary veins: Implications for catheter ablation of atrial fibrillation

Ricardo C. Cury, MD
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Suhny Abbara, MD
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Steven Schmidt, BS
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Zachary J. Malchano, BS
- Cardiac Arrhythmia Service, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Petr Neuzil, MD
- Cardiac Arrhythmia Service, Na Homolce Hospital, Prague, Czech Republic
Jiri Weichet, MD
- Cardiac Arrhythmia Service, Na Homolce Hospital, Prague, Czech Republic
Maros Ferencik, MD, PhD
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Udo Hoffmann, MD
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Jeremy N. Ruskin, MD
- Cardiac Arrhythmia Service, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Thomas J. Brady, MD
- Cardiac CT Unit, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
Vivek Y. Reddy, MD
- Cardiac Arrhythmia Service, Massachusetts General Hospital–Harvard Medical School, Boston, Massachusetts
- Address reprint requests and correspondence: Dr. Vivek Y. Reddy, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 109, Boston, Massachusetts 02114.

Received 1 August 2005; accepted 12 September 2005. published online 23 September 2005.

Background

A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures.

Objectives

The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA).

Methods

Sixty-five subjects underwent CT imaging using a 16-slice MDCT scanner: 24 with paroxysmal AF, 21 with chronic AF, and 20 “control” subjects without a history of AF. Measurements assessed included LA diameters, width of the esophagus and aorta in contact with the posterior LA wall, and distance from the esophagus to the four pulmonary veins (PVs), spine, and LA endocardium.

Results

Mean LA diameters were significantly larger in patients with AF vs the control group (P = .003 for anteroposterior diameter; P = .009 for transverse diameter). The anterior aspect of the esophagus was directly apposed to the LA in all cases (contact width 18.9 ± 4.4 mm). The position of the esophagus varied in the posterior mediastinum but on average was closer to the ostia of the left PVs (P = .0001). The descending aorta was in contact with the LA and/or left PVs in 50 of 65 subjects. The esophagus was closer to the spine in the chronic AF vs control group (P = .007), likely due to increased LA dimension.

Conclusion

In addition to its ability to assess PV anatomy, preprocedural MDCT imaging can investigate the variable relationship of adjacent structures, such as the esophagus and aorta to the LA and PVs.

Keywords: Catheter ablation , Multidetector computed tomography , Complications , Atrial fibrillation , Esophagus