CT-Scan Assessment of Anatomic Relation Between Left Atrial Posterior Wall and Esophagus, and Pulmonary Veins Isolation Post-Procedural Consequences

摘要

Pre-procedural three dimensional imaging using computed tomographic scan (CT-scan) could help identifying the precise relationship between the esophagus (E) and the left atrial and pulmonary veins posterior wall (LAPW and PVPW) to avoid RF applications along esophagus course. Post-procedural CT-scan allows to check the absence of vascular complications (PV occlusion or stenosis) and to assess esophagus integrity and anatomy. Electrical isolation of the pulmonary veins (PV) using radiofrequency (RF) ablation is now a well-established technique to cure paroxysmal or persistent atrial fibrillation (AF). Atrio-esophageal fistula (AEF) has recently been recognized as a serious, life threatening adverse event following surgical or endocardial RF ablation of AF. A recent experimental study has demonstrated that : 1. a high temperature wasn't necessary to the lesion formation. 2. a long time application increase the risk of esophageal lesion 3. the distance between the ablative catheter, and the esophagus is a crucial factor because it delimites a space playing a role of heat conductive tissue. The further the distance between esophagus and catheter is, the less important the risk is. The security threshold evocated is 4 mm.