Mechanical Displacement of the Esophagus in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation

Background: Left atrial (LA) ablation of atrial fibrillation (AF) may rarely be complicated by an atrio-esophageal fistula.

Objective: The purpose of this study was to determine the feasibility of mechanical displacement of the esophagus in patients undergoing LA ablation.

Methods: Twelve patients underwent mechanical displacement of the esophagus performed by an endoscopist during an LA ablation procedure under conscious sedation.

Results: The intrinsic course of the esophagus was near the left pulmonary veins (PVs) in 6 patients, the right PVs in 5 patients, and the mid-LA in 1 patient. In 10 (83%) of the 12 patients, the esophagus could be displaced with the endoscope. The maximal displacement toward the left-sided and right-sided PVs was 2.4 and 2.1 cm, respectively. In 2 (22%) of the 9 patients in whom a prior procedure was unsuccessful because of an unfavorable esophageal course, the esophagus remained at the same location to which it was displaced after removal of the endoscope, facilitating energy delivery at the target site. In the remaining 7 patients, the esophagus returned to its original location after the endoscope was removed. There were no complications related to the endoscopic procedure.

Conclusion: The esophagus can be mechanically displaced with an endoscope during an LA ablation procedure under conscious sedation. However, in most patients, the esophagus assumes its original course after removal of the endoscope. In some patients in whom PV isolation is problematic because of an unfavorable esophageal course, endoscopic displacement may facilitate safe energy delivery over the posterior LA.