PURPOSE: The aim of this study was to investigate the anatomic relationship around the left atrium (LA) and to provide clinical information to help avoid the risk of an atrio-esophageal fistula during atrial fibrillation (AF) ablation. METHODS: The multidetector spiral computed tomography images of 77 male patients (mean age, 54 ± 9 years) with drug-refractory AF and 37 male control subjects (mean age, 50 ± 11 years) were analyzed. We measured the following variables: (1) distance between the ostia of the pulmonary veins (PVs) and the ipsilateral esophageal border, (2) presence of a pericardial fat pad around each PV, and (3) contact width/length and presence of a fat pad between the LA and the esophagus. RESULTS: The distance between the esophagus and the ostia of right superior PV, right inferior PV (RIPV), left superior PV, and left inferior PV (LIPV) was 27.2 ± 9.4 mm, 22.9 ± 10.3 mm, 2.7 ± 9.4 mm, and 7.1 ± 8.8 mm, respectively. A fat pad between the esophagus and the superior PV was present in more than 90% of the subjects in both groups. However, the fat pad around inferior PV was present less frequently in the patients than in the control group (p = 0.011, RIPV; p < 0.001, LIPV). The average length of the LA-esophagus contact in the patients and the control group subjects was 26.2 ± 10.4 and 18.5 ± 5.1 mm, respectively (p < 0.001). CONCLUSION: Caution should be exercised when ablating the LIPV because the esophagus is located in close proximity to the left-sided PV and most of the inferior PVs in patients with AF are not covered with fat pads.
PURPOSE: The aim of this study was to investigate the anatomic relationship around the left atrium (LA) and to provide clinical information to help avoid the risk of an atrio-esophageal fistula during atrial fibrillation (AF) ablation. METHODS: The multidetector spiral computed tomography images of 77 male patients (mean age, 54 ± 9 years) with drug-refractory AF and 37 male control subjects (mean age, 50 ± 11 years) were analyzed. We measured the following variables: (1) distance between the ostia of the pulmonary veins (PVs) and the ipsilateral esophageal border, (2) presence of a pericardial fat pad around each PV, and (3) contact width/length and presence of a fat pad between the LA and the esophagus. RESULTS: The distance between the esophagus and the ostia of right superior PV, right inferior PV (RIPV), left superior PV, and left inferior PV (LIPV) was 27.2 ± 9.4 mm, 22.9 ± 10.3 mm, 2.7 ± 9.4 mm, and 7.1 ± 8.8 mm, respectively. A fat pad between the esophagus and the superior PV was present in more than 90% of the subjects in both groups. However, the fat pad around inferior PV was present less frequently in the patients than in the control group (p = 0.011, RIPV; p < 0.001, LIPV). The average length of the LA-esophagus contact in the patients and the control group subjects was 26.2 ± 10.4 and 18.5 ± 5.1 mm, respectively (p < 0.001). CONCLUSION: Caution should be exercised when ablating the LIPV because the esophagus is located in close proximity to the left-sided PV and most of the inferior PVs in patients with AF are not covered with fat pads.
Authors: Jennifer E Cummings; Robert A Schweikert; Walid I Saliba; J David Burkhardt; Johannes Brachmann; Jens Gunther; Volker Schibgilla; Atul Verma; MarkAlain Dery; John L Drago; Fethi Kilicaslan; Andrea Natale Journal: Circulation Date: 2005-07-18 Impact factor: 29.690
Authors: Gerold Mönnig; Johannes Wessling; Kai U Juergens; Peter Milberg; Michael Ribbing; Roman Fischbach; Johannes Wiekowski; Günter Breithardt; Lars Eckardt Journal: Europace Date: 2005-11 Impact factor: 5.214
Authors: Kristina Lemola; Michael Sneider; Benoit Desjardins; Ian Case; Jihn Han; Eric Good; Kamala Tamirisa; Ariane Tsemo; Aman Chugh; Frank Bogun; Frank Pelosi; Ella Kazerooni; Fred Morady; Hakan Oral Journal: Circulation Date: 2004-11-29 Impact factor: 29.690
Authors: Sheldon M Singh; Andre d'Avila; Shephal K Doshi; William R Brugge; Rudolph A Bedford; Theofanie Mela; Jeremy N Ruskin; Vivek Y Reddy Journal: Circ Arrhythm Electrophysiol Date: 2008-08
Authors: Aman Chugh; Joel Rubenstein; Eric Good; Matthew Ebinger; Krit Jongnarangsin; Jackie Fortino; Frank Bogun; Frank Pelosi; Hakan Oral; Timothy Nostrant; Fred Morady Journal: Heart Rhythm Date: 2008-12-07 Impact factor: 6.343