Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation.

Abstract:

BACKGROUND:Esophageal injury is a potential complication after intraoperative or percutaneous transcatheter ablation of the posterior aspect of the left atrium. Understanding the spatial relations between the esophagus and the left atrium is essential to reduce risks. METHODS AND RESULTS:We examined by gross dissection the course of the esophagus in 15 cadavers. We measured the minimal distance of the esophageal wall to the endocardium of the left atrium with histological studies in 12 specimens. To measure the transmural thickness of the atrial wall, we sectioned another 30 human heart specimens in the sagittal plane at 3 different regions of the left atrium. The esophagus follows a variable course along the posterior aspect of the left atrium; its wall was <5 mm from the endocardium in 40% of specimens. The posterior left atrial wall has a variable thickness, being thickest adjacent to the coronary sinus and thinnest more superiorly. Behind is a layer of fibrous pericardium and fibrofatty tissue of irregular thickness that contains esophageal arteries of 0.4+/-0.2-mm external diameters. CONCLUSIONS:The nonuniform thickness of the posterior left atrial wall and the variable fibrofatty layer between the wall and the esophagus are risk factors that must be considered during ablation procedure. Esophageal arteries and vagus nerve plexus on the anterior surface of the esophagus may be affected by ablative procedures.

journal_name

Circulation

journal_title

Circulation

authors

Sánchez-Quintana D,Cabrera JA,Climent V,Farré J,Mendonça MC,Ho SY

doi

10.1161/CIRCULATIONAHA.105.551291

subject

Has Abstract

pub_date

2005-09-06 00:00:00

pages

1400-5

issue

10

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.105.551291

journal_volume

112

pub_type

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