Esophageal Tissue Injury Following Pulmonary Vein Isolation Using the PVAC: Assessment by Endoscopy and Magnetic Resonance Imaging
Disclosures: There are no ethical problems related to the material. The study was not supported by industry. Christian von Bary received grants <5000 €/year from Medtronic for consultation. None of the other authors have any disclosures.
Address for reprints: Christian von Bary, M.D., Medizinische Klinik I, Rotkreuzklinikum München, Lehrkrankenhaus der Technischen Universität München, Nymphenburgerstrasse 163, 80634 Munich, Germany. Fax: 49-89-1303-2505; e-mail: email@example.com
We investigate the frequency of esophageal tissue injury (ETI) following ablation of atrial fibrillation (AF) using the pulmonary vein ablation catheter (PVAC) ascertained by esophageal endoscopy (ESE) and corresponding magnetic resonance imaging (MRI).
A total of 41 patients with symptomatic AF presenting for pulmonary vein isolation (PVI) were included consecutively in two observational groups. Group A received MRI the day before and ESE plus MRI within 3–4 weeks following the ablation procedure using the PVAC. Group B received MRI the day before and ESE plus MRI within 2 days after PVI. MRI included T2-weighted and T1-weighted postcontrast with fat suppression (fs) and late-enhancement scans to demonstrate postprocedural edema and contrast enhancement of the esophageal wall.
A total of 13 (32%) patients were enrolled in Group A (26 ± 11 days post-PVI), and 28 (68%) patients in Group B (2 ± 0.6 days post-PVI). ETI was found by ESE in one (2%) patient (Group B) and resolved under conservative therapy. Corresponding MRI showed a false negative result with no alterations of esophageal structures using T1-weighted, T2-weighted, and late enhancement scans. In addition, false positive results were demonstrated by late-enhancement MRI in five (12%) patients (three patients in Group A and two patients in Group B), which could not be verified by corresponding ESE.
Endoluminal ETI is a rare but possible complication, which should be considered following PVAC procedures. MRI of the esophagus is currently not a reliable screening method due to false positive and negative findings compared to ESE.