Oral Contrast Agent Guided Atrial Fibrillation Radiofrequency Ablation For Reducing Postoperative Esophageal Lesion

Background:Radiofrequency catheter ablation is an effective therapy in patients with atrial fibrillation and is widely used in clinic. According to the AHA/ACC/2014HRS guidence for atrial fibrillation, AF catheter ablation is useful for symptomatic paroxysmal AF refractory or intolerant to at least1class I or III antiarrhythmic medication when a rhythm control strategy is desired. Left atrial esophageal fistula is well known as a serious complication of radiofrequency ablation of atrial fibrillation. A lot of research attempt to reduce the esophageal lesion postoperation in many ways.Expect limiting the RF energy and temperature outputs to a prespecified lower value for the posterior wall of LA, there is no effective and convenient way can reduce postoperative esophageal lesions.We tried to confirmed the position of esophagus by oraling contrast agent and describe the extent of esophageal mobility that occurs during catheter ablation for atrial fibrillation under conscious sedation.Real-time monitoring of the esophageal location behind the LA tells us both where we can ablate and where we should avoid ablation.And in this way can reduce the incidence of postoperative esophageal lesions.The purpose of our study was to prospectively investigate the incidence of esophageal lesion will be reduced in this way.Method:Sixty-six patients which enter Sir Run Run Shaw Hosiptial for paroxysmal atrial fibrillation radiofrequency ablation. We performed a1:1-randomization as follows:Control group:oral contrast agent postoperation and confirmed the position of esophagus and ablation line,n=36.Visualization group:oral contrast agent preoperation, after ablating the pulmonary vein near the esophagus and postoperation. Ablation was guided by the contrast.n=30.All patients underwent ultrasonic gastroscopy in24h after the operation to judge the presence of esophageal lesions.Result:Most of the esophagus move in the negative direction of ablation line after ablating the pulmonary vein near the esophagus,77.3%(P<0.05) at superior-,81.8%(P<0.05) at mid-, and68.2%at inferior levels. Most of the esophagus move in the direction of ablation line after ablating the pulmonary vein away from the esophagus,54.5%at superior-,77.3%(P<0.05) at mid-, and72.7%at inferior levels.. We found6patients (16.7%) presenting esophageal lesion in control group. We found2patients (6.7%) presenting esophageal lesion in visualization group, P>0.05vs control group. We found20patients(55.6%) ablating away from esophagus in control group. We found25patients(83.3%) ablating away from esophagus in visualization group,P<0.05vs control group.We found1patient (2.2%) presenting esophageal lesion after ablating away from esophagus.We found7patient (28.5%) presenting esophageal lesion after ablating not away from esophagus, P<0.05vs ablating away from esophagus.Conclusion:Esophagus move in the negative direction of ablation line after ablating the pulmonary vein near the esophagus. And then esophagus move in the direction of ablation line after ablating the pulmonary vein away from the esophagus. Oraling contrast agent to guide atrial fibrillation ablation can increase the success rate of the ablating away from esophagus which can reduce the incidence of postoperative esophageal lesions.