Abstract
A 54-year-old man was referred for ablation of symptomatic drug-refractory long-lasting persistent atrial fibrillation. His past medical history was negative for cardiac disease but included a diagnosis of esophageal achalasia. The patient underwent an ablation procedure, guided by barium esophagram, including isolation of the pulmonary veins, ablation of complex fractionated left atrial electrograms recorded on the sep-tal wall and, finally, linear ablation of the cavo-tricuspid isthmus. The ablation procedure was performed with multielectrode ablation catheters using duty-cycled bipolar/unipolar radiofrequency energy. During 6 months of follow-up no recurrences of atrial fibrillation were documented. The reported case demonstrates how an ablation procedure for long-standing persistent AF may be safely performed even in a patient presenting with a achalasia, outlining the mega-esophagus position with a simple barium paste.
Highlights
At the present time, a number of different approaches are being employed to avoid esophagus-related complications during atrial fibrillation (AF) ablation procedures [1,2,3,4,5,6]
A 54-year-old man was referred for ablation of symptomatic drug-refractory long-lasting persistent atrial fibrillation
The patient underwent an ablation procedure, guided by barium esophagram, including isolation of the pulmonary veins, ablation of complex fractionated left atrial electrograms recorded on the septal wall and, linear ablation of the cavo-tricuspid isthmus
Summary
A number of different approaches are being employed to avoid esophagus-related complications during atrial fibrillation (AF) ablation procedures [1,2,3,4,5,6]. Barium paste, outlining the esophageal position in real time for the duration of the procedure, may provide an effective approach to minimize the potential risk of thermal injury when delivering radiofrequency (RF) energy at the posterior wall of the left atrium (LA), in close proximity to the esophagus [7]. Successfully used to perform safely RF ablation of longstanding persistent AF in a patient with a megaesophagus due to achalasia, a rare neurodegenerative disease resulting in abnormal esophageal motility and impaired relaxation of lower esophageal sphincter [8]
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