Study: Imaging could drop chance of injury in atrial fibrillation procedures

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There is a new experimental imaging procedure that shows promise in reducing the risk of esophageal injury in patients undergoing catheter ablation for atrial fibrillation (AF), according to a study to be published in the September edition of Heart Rhythm.
           
The study looked at the use of intracardiac echocardiography (ICE) in providing real-time imaging of the esophagus to evaluate the ablation, and to monitor potential complications that may result from ablation. The study involved 152 patients who underwent left atrial ablation for AF.
           
“ICE imaging could be a valuable tool to protect patients from esophageal injury and help physicians do no harm,” said Francis Marchlinski, MD, 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.”
           
Hugh Calkins, MD, professor of medicine and director of the electrophysiology lab at Johns Hopkins Hospital, wrote in an accompanying editorial that, “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 ICE may have promise in this regard.”
           
The development of these lesions on the esophagus is “perhaps the most feared, and most lethal of the many complications that have been associated with this procedure…with mortality in excess of 75 percent,” Calkins wrote.
           
However, the study does not prove that ICE will prevent esophageal injury in the future and that more studies are needed, Calkins noted.