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Review
. 2021 Dec 21;67(3):95-101.
doi: 10.5387/fms.2021-23. Epub 2021 Nov 20.

Esophageal thermal injury in catheter ablation of atrial fibrillation

Takashi Kaneshiro  1 , Yasuchika Takeishi  1
Affiliations
Review

Esophageal thermal injury in catheter ablation of atrial fibrillation

Takashi Kaneshiro et al. Fukushima J Med Sci. .

Abstract

Pulmonary vein isolation is an established method for the catheter ablation of atrial fibrillation. Esophageal thermal injuries, such as esophageal erosion, ulceration and periesophageal nerve injury leading to gastric hypomotility, are important complications associated with pulmonary vein isolation. In this review article, we describe the mechanisms, characteristics and the predictors of esophageal thermal injury associated with pulmonary vein isolation.

Keywords: atrial fibrillation; catheter ablation; esophageal mucosal lesion; esophageal thermal injury; periesophageal nerve injury.

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Figures

Fig. 1.
Fig. 1.
Schematic image of 3-dimenonal navigation system during radiofrequency pulmonary vein isolation. Postero-anterior view of 3-dimenonal navigation system during radiofrequency pulmonary vein isolation. The ostium of each PV was circumferentially ablated using radiofrequency ablation catheter. PV, pulmonary vein.
Fig. 2.
Fig. 2.
X-ray images during cryoballoon pulmonary vein isolation. Cryoballoon catheter was positioned and occluded the ostium of left superior PV. PV, pulmonary vein.
Fig. 3.
Fig. 3.
The parameters used to evaluate proximities of the esophagus to its surrounding structures on the computed tomography data. A: LA-Ao angle: the angle of the LA posterior wall to the descending Ao. B: LIPV angle: the branching angle of the LIPV to the coronal plane. C: LA-Ao distance: the distance between the descending Ao and LA posterior wall. Ao, aorta; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein. Modified from the figure in the article by Kaneshiro T, et al.
Fig. 4.
Fig. 4.
Representative case of esophageal thermal injury in radiofrequency pulmonary vein isolation. The panel A shows esophageal erosion and the panel B shows gastric hypomotility, which were revealed by esophagogastroduodenoscopy performed after PVI. PVI, pulmonary vein isolation. Modified from the figure in the article by Kaneshiro T, et al.
Fig. 5.
Fig. 5.
Representative cases of esophageal thermal injury in cryoballoon pulmonary vein isolation. The panel A shows esophageal erosion and the panel B shows gastric hypomotility, which were revealed by esophagogastroduodenoscopy performed after PVI. PVI, pulmonary vein isolation. Modified from the figure in the article by Matsumoto Y, et al.
Fig. 6.
Fig. 6.
Representative cases of esophageal thermal injury in high-power short-duration and conventional ablations. The panel A shows a representative figure of esophageal erythema (arrow) in the high power-short duration setting. The panel B shows a representative figure of esophageal ulcer in the conventional setting. The panel C shows a representative figure of gastric hypomotility in the high-power short-duration setting. Modified from the figure in the article by Kaneshiro T, et al.
See this image and copyright information in PMC

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