Electroanatomical mapping of the esophagus in circumferential pulmonary vein isolation.

A virtual reconstruction of the geometry of the esophagus was produced using an electroanatomical mapping system and a specially designed catheter in 20 consecutive patients undergoing circumferential pulmonary vein isolation. The course of the esophagus, its motion and its proximity to the predicted lines of application of radiofrequency energy to the left atrium were evaluated. Thirteen (65%) were located centrally (i.e. >10 mm from the ostium), 69 (30%) laterally (i.e. <10 mm from the ostium) and 1 (5%) obliquely. No movements larger than 10 mm occurred during the procedure. Conventionally, the radiofrequency ablation lines are configured such that, in 50% of patients, radiofrequency energy is applied to areas adjacent to the esophagus. In order to decrease the potential risk associated with this procedure, either the position of the ablation lines was altered to bring them closer to the ostium (by 15%) or the power was reduced (by 35%). Although there was no significant movement of the esophagus during the ablation procedure, its course was variable. Consequently, the ablation strategy was altered in a substantial number of cases.

Cartografía electroanatómica del esófago en el aislamiento circunferencial de venas pulmonares / Electroanatomical mapping of the esophagus in circumferential pulmonary vein isolation

Realizamos una reconstrucción virtual de la geometría del esófago con un sistema de cartografía electroanatómica utilizando un catéter específico en 20 pacientes consecutivos sometidos a aislamiento circunferencial de venas pulmonares. Monitorizamos el trayecto esofágico y sus movilizaciones, valorando la proximidad a las líneas de aplicación de radiofrecuencia previstas en la aurícula izquierda. Trece (65%) fueron centrales (> 10 mm de los ostia), 6 (30%) laterales ( < 10 mm) y 1 (5%) oblicuo. No hubo movilizaciones > 10 mm durante el procedimiento. La disposición convencional de las líneas de ablación suponía la aplicación de radiofrecuencia en zonas adyacentes al esófago en el 50% de los pacientes. Intentando reducir el riesgo potencial de estas aplicaciones, se modificó su posición aproximándolas a los ostia (15%) o se disminuyó la potencia (35%). El esófago demuestra una disposición variable sin desplazamientos significativos durante el procedimiento de ablación. Esto implica modificar la estrategia de ablación en un número considerable de casos (AU)

A virtual reconstruction of the geometry of the esophagus was produced using an electroanatomical mapping system and a specially designed catheter in 20 consecutive patients undergoing circumferential pulmonary vein isolation. The course of the esophagus, its motion and its proximity to the predicted lines of application of radiofrequency energy to the left atrium were evaluated. Thirteen (65%) were located centrally (i.e. >10 mm from the ostium), 69 (30%) laterally (i.e. <10 mm from the ostium and 1 5 obliquely no movements larger than 10 occurred during procedure conventionally radiofrequency ablation lines are configured such that in 50 of patients energy is applied to areas adjacent esophagus order decrease potential risk associated with this either position was altered bring them closer by 15 or power reduced 35 although there significant movement its course variable consequently strategy a substantial number cases (AU)