Abstract
Atrioesophageal fistula is one of the most serious complications of pulmonary vein (PV) isolation. We describe a technique to monitor esophageal position during this procedure. A 39-year-old patient with atrial fibrillation underwent pulmonary vein isolation under guidance of the EnSite NavXTM electroanatomic navigation system. To avert unintentional esophageal injury, a tetrapolar electrode for transesophageal stimulation was inserted by nasogastric access, advanced to a retroatrial position, and connected to the NavXTM system. The image shows a cranial view (A) and a posterior view (B), with the tetrapolar electrode (dark blue) within the esophagus between the 2 ablation lines around the right and left pulmonary veins, and at a distance from the roof line (red dots). The electrode used as reference is seen at the level of the interventricular septum. This technique allows continuous visualization of the esophageal position; hence, the operator can avoid application of radiofrequency in the vicinity of the IMAGE IN CARDIOLOGY
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