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PV isolation guided by esophageal visualization with a tailored ablation strategy for the avoidance of esophageal thermal injury: a randomized trial

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Radiofrequency ablation along the posterior wall of the left atrium may lead to atrioesophageal fistula due to esophageal thermal injury. The purpose of our study was to prospectively investigate whether ablation guided by soluble contrast esophageal visualization (SCEV) reduces injury during atrial fibrillation (AF) ablation.

Methods

Seventy-eight patients with paroxysmal AF undergoing circumferential pulmonary vein isolation (PVI) were randomized to a SCEV group (n = 39) and control group without visualization (n = 39). Cine imaging of the esophagus was performed during soluble contrast swallowing at the beginning of ablation, after adjacent ipsilateral PVI and at the end of the procedure. The ablation lesion set was modified to avoid radiofrequency delivery within the contrast esophagram boundaries. In the control group, a single final ingestion was performed at the end of the procedure. Esophageal injury was assessed by esophagogastroscopy within 24 h in all patients.

Results

In the control group, the ablation lesion crossed over the esophagus in 46.2% of patients, whereas in SCEV group, the ablation line violated the boundaries of the esophagus unavoidably in 15.4% of patients (confidence interval (CI); 1.61–13.98, p = 0.003). The incidence of esophageal injury was significantly lower in patients that underwent ablation with SCEV (5.1% vs. 20.5%, CI; 0.04–1.06, p = 0.042). Regardless of randomization group, patients who received ablation which overlapped the esophagus had a higher incidence of esophageal injury compared with those without overlap (37.5 vs. 1.9%, CI; 3.73–271.37, p = 0.000).

Conclusions

Esophageal contrast visualization helps to reduce the potential for esophageal injury during paroxysmal AF ablation. This simple procedural adjunct has important implications to improve safety of paroxysmal AF ablation procedures globally.

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Acknowledgments

We thank Professor Roderick Tung, MD, FHRS, and Professor Michael M. Shehata MD, FHRS from USA and Clement Lau, MBChB from UK for their help in the English writing, editing, and thoughtful review of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, People’s Republic of China

    Yang Ye, Shi-quan Chen, Yi-fei Lu, Ru-hong Jiang, Qiang Liu, Xia Sheng, Zuwen Zhang, Ya-xun Sun, Pei Zhang, Lu Yu, Meng-meng Chen, Guo-sheng Fu & Chen-yang Jiang

  2. Department of Cardiology, Taizhou Hospital of Zhejiang province, Linhai Taizhou, 317000, Zhejiang, People’s Republic of China

    Yi-fei Lu

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  1. Yang Ye
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Ye, Y., Chen, Sq., Lu, Yf. et al. PV isolation guided by esophageal visualization with a tailored ablation strategy for the avoidance of esophageal thermal injury: a randomized trial. J Interv Card Electrophysiol 58, 219–227 (2020). https://doi.org/10.1007/s10840-019-00572-5

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