Red Alert

Red Alert EDITORIAL Infrared Thermography for Esophageal Monitoring See Article by Daly et al Ryan T. Borne, MD Duy T. Nguyen, MD ulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Although atrioesophageal fistula is a known but rare Pcomplication, with an estimated incidence of <0.25% after conventional radio- 2–4 frequency ablation, it is highly morbid and often fatal. Given that ablation of AF is an increasingly used modality of treatment, and ablation over the posterior wall is an essential and unavoidable aspect of catheter ablation of AF, the risk of atrioesopha- geal fistula will continue to be a feared complication in the care of these patients. Multiple methods have been developed and used with the intent of reducing esophageal injury (Figure). Ablation strategies have been used to avoid ablation di- rectly over the esophagus, including visualization of the esophagus based on com- puterized tomography, topographical tagging with an electroanatomic mapping system, barium paste, and intracardiac echocardiography. However, the esophagus can change position and, at times, ablation over the esophagus is necessary, mak- ing these strategies difficult and requiring continuous imaging or visualization to account for motion. Higher power and greater depth of tissue heating are http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Circulation: Arrhythmia & Electrophysiology Wolters Kluwer Health

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Publisher
Wolters Kluwer
Copyright
© 2018 American Heart Association, Inc.
ISSN
1941-3149
eISSN
1941-3084
D.O.I.
10.1161/CIRCEP.118.006113
Publisher site
See Article on Publisher Site

Abstract

EDITORIAL Infrared Thermography for Esophageal Monitoring See Article by Daly et al Ryan T. Borne, MD Duy T. Nguyen, MD ulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Although atrioesophageal fistula is a known but rare Pcomplication, with an estimated incidence of <0.25% after conventional radio- 2–4 frequency ablation, it is highly morbid and often fatal. Given that ablation of AF is an increasingly used modality of treatment, and ablation over the posterior wall is an essential and unavoidable aspect of catheter ablation of AF, the risk of atrioesopha- geal fistula will continue to be a feared complication in the care of these patients. Multiple methods have been developed and used with the intent of reducing esophageal injury (Figure). Ablation strategies have been used to avoid ablation di- rectly over the esophagus, including visualization of the esophagus based on com- puterized tomography, topographical tagging with an electroanatomic mapping system, barium paste, and intracardiac echocardiography. However, the esophagus can change position and, at times, ablation over the esophagus is necessary, mak- ing these strategies difficult and requiring continuous imaging or visualization to account for motion. Higher power and greater depth of tissue heating are

Journal

Circulation: Arrhythmia & ElectrophysiologyWolters Kluwer Health

Published: Feb 1, 2018

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