WJCD  Vol.2 No.4 , October 2012
Successful radiofrequency ablation of long-standing persistent atrial fibrillation in a patient with esophageal achalasia
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.

Cite this paper
Avella, A. , De Girolamo, P. , Laurenzi, F. , Pappalardo, A. and Buffa, V. (2012) Successful radiofrequency ablation of long-standing persistent atrial fibrillation in a patient with esophageal achalasia. World Journal of Cardiovascular Diseases, 2, 302-304. doi: 10.4236/wjcd.2012.24047.
References
[1]   Lemola, K., Sneider, M., Desjardins, B., et al. (2004) Computed tomographic analysis of the anatomy of the left atrium and the esophagus: Implications for left atrial catheter ablation. Circulation, 110, 3655-3660. http://dx.doi.org/10.1161/01.CIR.0000149714.31471.FD

[2]   Kottkamp, H., Piorkowski, C., Tanner, H., et al. (2005) Topographic variability of the esophageal left atrial relation influencing ablation lines in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 16, 146-150. http://dx.doi.org/10.1046/j.1540-8167.2005.40604.x

[3]   Redfearn, D.P., Trim, G.M., Skanes, A.C., et al. (2005) Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 16, 589-593. http://dx.doi.org/10.1111/j.1540-8167.2005.40825.x

[4]   Cummings, J.E., Schweikert, R.A., Saliba, W.I., et al. (2005) Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation, 112, 459-464. http://dx.doi.org/10.1161/CIRCULATIONAHA.104.509612

[5]   Ren, J.F., Marchlinski, F.E. and Callans, D.J. (2006) Real time intracardiac echocardiographic imaging of the posterior left atrial wall contiguous to anterior wall of the esophagus. Journal of the American College of Cardiology, 48, 594-595. http://dx.doi.org/10.1016/j.jacc.2006.05.019

[6]   Ren, J.F., Lin, D., Marchlinski, F.E., et al. (2006) Esophageal imaging and strategies for avoiding injury during left atrial ablation for atrial fibrillation. Heart Rhythm, 3, 1156-1161. http://dx.doi.org/10.1016/j.hrthm.2006.06.006

[7]   Good, E., Oral, H., Lemola, K., et al. (2005) Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. Journal of the American College of Cardiology, 46, 2107-2110. http://dx.doi.org/10.1016/j.jacc.2005.08.042

[8]   Richards, W.O., Torquati, A. and Lutfi, R. (2005) The cur- rent treatment of achalasia. Advances in Surgery, 39, 285-314.

[9]   Ghia, K.K., Chugh, A., Good, E., et al. (2009) A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. Journal of Interventional Cardiac Electrophysiology, 24, 33-36. http://dx.doi.org/10.1007/s10840-008-9307-1

 
 
Top