Visualization of the esophagus during ablation
Visualization of the esophagus and LA during the ablation procedure can
contribute to a reduced risk of esophagus damage. Several techniques
have been used to locate the esophagus either before or during AF
ablation, but they all have certain limitations. Since the esophagus is
mobile structure, preprocedural imaging of the esophagus by CT does not
always reflect the position of the esophagus during
procedure.11,12 Beside, contrast esophagography by
asking the patient to swallow the contrast medium just before the
procedure can outline the esophageal lumen clearly on fluoroscopy,7,8 but it cannot display the distance between the
esophagus and LA endocardium at the site of ablation. An esophageal
temperature probe to monitor esophageal temperature is widely
used.5,6 However, esophageal temperature prove cannot
cover the whole esophagus lumen, so that it may not accurately reflect
the esophageal intramural tissue temperature because of the variable and
unpredictable distance between the temperature probe and the ablation
catheter tip.
In the present study, we created the 3D esophagus image adjacent to the
LAPW by inserting the Carto SoundStar® catheter into
the LA cavity and with the assist of the CartoMergeTMmodule. This method allowed us to visualize the 3D esophagus image
clearly during PV isolation, and therefore we could adjust safely AI
value while confirming the distance between the ablation catheter tip
and the esophagus.