Purpose

Localization of the esophagus and the left atrium (LA) posterior wall thickness (LAPWT) should be taken into account when delivering radiofrequency energy. To validate the visualization of the esophagus and analyze LAPWT by ICE advanced into the LA in patients with atrial fibrillation (AF) undergoing ablation index (AI)-guided pulmonary vein (PV) isolation.

Methods

In 73 patients (mean age, 68 ± 12; paroxysmal AF in 45), a 3-dimensional (3D) esophagus image was created with CARTO Soundstar^Ⓡ and its location was compared with contrast esophagography saved in Carto UNIVU™. LAPWT adjacent to the esophagus was measured at 4 levels: left superior PV (LSPV), intervenous carina (IC), left inferior PV (LIPV), and LIPV bottom. A target AI value was 260 (25 W power) on the esophagus demonstrated by ICE.

Results

All patients had the esophagus posterior to the left PV antrum. Creating a 3D esophagus and measurement of LAPWT with ICE was done without any complications. ICE esophagus image was completely overlapped with contrast esophagography. LAPWT (mm) was 2.8 (interquartile range, 2.5–3.2), 2.2 (1.9–2.5), 1.9 (1.8–2.1), and 2.1 (1.9–2.4) for LSPV, IC, LIPV, and LIPV bottom, respectively, while LA roof thickness was 3.2 (2.9–3.6) (P < 0.0001 by ANOVA). No residual conduction gap on the esophagus after the first circumferential PV isolation was found in 64 of 73 (88%) patients.

Conclusions

ICE inserted into the LA can reliably locate and display the esophagus and its relationship to the LA. LAPWT was the thinnest at the LIPV level. AI-guided ablation targeting at AI value 260 on the esophagus seemed to be effective.

中文翻译：

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左心房内超声心动图实时显示食管和左心房后壁

目的

在提供射频能量时，应考虑食道和左心房 (LA) 后壁厚度 (LAPWT) 的定位。在接受消融指数 (AI) 引导的肺静脉 (PV) 隔离的房颤 (AF) 患者中，验证食管的可视化并通过 ICE 分析 LAPWT 进入 LA。

方法

在 73 名患者（平均年龄，68 ± 12；45 名阵发性 AF）中，使用 CARTO Soundstar ^Ⓡ创建了 3 维 (3D) 食管图像，并将其位置与 Carto UNIVU™ 中保存的造影食管造影进行了比较。食道附近的 LAPWT 在 4 个水平上进行测量：左上 PV (LSPV)、中间隆突 (IC)、左下 PV (LIPV) 和 LIPV 底部。ICE 显示食道上的目标 AI 值为 260（25 W 功率）。

结果

所有患者的食道均位于左 PV 窦后方。创建 3D 食管并使用 ICE 测量 LAPWT 没有任何并发​​症。ICE 食管图像与对比食管造影完全重叠。LSPV、IC、LIPV 和 LIPV 底部的 LAPWT (mm) 分别为 2.8（四分位距，2.5-3.2）、2.2（1.9-2.5）、1.9（1.8-2.1）和 2.1（1.9-2.4），而洛杉矶屋顶厚度为 3.2 (2.9–3.6)（ 方差分析P < 0.0001）。在 73 名患者中的 64 名 (88%) 患者中，在第一次圆周 PV 隔离后没有发现食道上的残留传导间隙。

结论

插入 LA 的 ICE 可以可靠地定位和显示食道及其与 LA 的关系。LAPWT 在 LIPV 水平上是最薄的。针对食道上 AI 值 260 的 AI 引导消融似乎是有效的。