Imaging Technique May Prevent Injury During Ablation for Atrial Fibrillation

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Risk of Esophageal Injury

A new imaging procedure may reduce the risk of esophageal injury in patients undergoing catheter ablation for atrial fibrillation (AF), according to a study published in the September 2006 edition of Heart Rhythm. Researchers used intracardiac echocardiography (ICE) to provide real-time imaging of the esophagus to gauge the power, temperature and duration of the ablation, and to monitor the development of lesions and other potential complications that may result from ablation.

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The study, involving 152 patients who underwent left atrial ablation for AF, is the first to identify the esophagus and monitor lesions, known as atrio-esophageal fistulas, on the posterior wall of the heart's left atrium with intracardiac echocardiography.

"ICE imaging could be a valuable tool to protect patients from esophageal injury and help physicians do no harm," says Francis Marchlinski, M.D., director of the University of Pennsylvania's electrophysiology program and an author of the study. "Although this complication is rare, it results in high mortality."

In an accompanying editorial, Hugh Calkins, M.D., professor of medicine and director of the electrophysiology lab at Johns Hopkins Hospital, writes "There is no question that those involved with catheter ablation of AF urgently need a method to protect the esophagus and prevent further atrio-esophageal fistulas. And based on the results of this study, it appears that

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