Abstract 15440: Staging of Esophageal Enhancement After Atrial Fibrillation Ablation, Utility of MRI After Ablation
Introduction: Esophagus is particularly prone to thermal injury during radiofrequency (RF) atrial fibrillation (AF) ablation.Currently, no early detection methods have been routinely employed.
Hypothesis: We hypothesized that delayed enhancement MRI (DEMRI) can be used to detect esophageal injury (EI) post ablation.
Methods: In 2012, we identified 100 patients that underwent RF AF ablation, who underwent 3 DEMRI scans: prior to, within 24 hours and 3 months after ablation. EI from DEMRI was classified as none (Group (Gr) 0), < 50% anterior wall (Gr I), ≥ 50% anterior wall without posterior esophageal wall (Gr 2), involvement of both anterior and posterior esophageal wall (Gr 3) (figure). Patient may have received an additional MRI within 24hr to one week follow up EI, based on physician’s decision.
Results: Mean age was 66 years old (95% CI; 63.7-68.3) with 68.3% were male. The mean CHADS2, CHA2DS2-VASC and HAS-BLED scores were 1.60 (1.34-1.87), 2.63 (2.29-2.98) and 1.92 (1.69-2.15) respectively. No patient had EI prior to ablation or were in Gr 3 post ablation. Using proton pump inhibitors prior to ablation is not protective against EI. 55% had EI at DEMRI within 24hr after ablation (31 with Gr 1 and 24 with Gr 2). 2 patients (4.4%) of Gr 0, 1 patient (3.2%) of Gr I and 8 patients (12.5%) of Gr 2 had GI symptoms. In Gr I, 7 patients had an additional MRI, 5 had EI resolution, 2 had persistent Gr 1 finding. 2 patients underwent endoscopy and showed normal esophagus. In Gr 2, 19 patients had an additional MRI, 10 had complete resolution, 8 had EI decrease to Gr 1 and 1 had persistent EI in Gr 2. Patient with persistent enhancement, also had symptoms, had esophageal ulcer. At 3 months, all DEMRI of esophagus returned to normal.
Conclusion: EI after AF ablation is common and usually benign, but persistent EI (especially anterior wall enhancement without posterior wall involvement) after 24hr post ablation is concerning and may require further investigation/treatment.
- © 2013 by American Heart Association, Inc.