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Background. Damage to the esophagus during radiofrequency ablation of atrial fibrillation can result in fatal atrioesophageal fistula. Our aim is to describe the relationship of the left atrium (LA) and esophagus with a focus on contact of the posterior wall (PW) of the LA and the esophagus. Methods. From 9/2011 to 8/2012, CT of the heart was performed in 56 patients undergoing catheter ablation of atrial fibrillation using CT GE Lightspeed VCT 64 by nongated standard protocol. Positions of the esophagus to the LA, width of the esophagus and contact with the PW of the LA were determined. Results. The most frequent position of the esophagus was behind the left side of the LA. The average width of the esophagus was 16.0 ± 4.1 mm, and the average distance between the PW and esophagus was 4.8 ± 1.6 mm. On average, 50 ± 4.11 mm of the PW was in close contact with the esophagus. The average length of the fat pad between the esophagus and LA was 9.1 ± 5.5 mm in the upper part of the LA and 15.8 ± 7.3 mm at the bottom. Significantly longer contact occurred behind the right part of the LA. Conclusions. The most common esophageal position is behind the left side of the LA. The esophagus is located in close contact by approximately 2/3 of the length and 1/4 of the width of the PW of the LA. The esophagus is more adjacent to the upper part of PW of the LA. [ABSTRACT FROM AUTHOR]

Background. Three-dimensional rotational angiography (3DRA) of the heart is an imaging technique that displays the left atrium and adjacent structures during catheter ablation of atrial fibrillation. The aim is to evaluate the feasibility and safety of 3DRA for imaging the right and left ventricles of patients undergoing catheter ablation of ventricular arrhythmias. Methods. From 8/2010 to 6/2015, 35 patients underwent 3DRA of the right (20 patients) or left ventricle (15 patients) with a Philips Allura FD 10 X-ray system using a direct protocol. The success rate of the 3D model, as well as the procedure times and complications of 3DRA, was evaluated, and the 3DRA model was compared with ventricular computer tomography (CT). Results. The overall 3D model success rate was 91.4%. The 3D models were graded as excellent for 65.7% of patients and as useful for 25.7% of patients. The imaging success rate was slightly higher for the right ventricle than for the left ventricle (95%, 86.7%, respectively). The times required to perform 3DRA of the right and left ventricle were 12.5 +/- 2.1 min and 14.7 +/- 2.8 min, respectively. There were no significant differences between 3DRA and ventricular CT. Conclusion. Ventricular 3DRA allows the easy and safe creation of 3D models of the cardiac ventricles. The success rate is comparable to the success rate of the 3DRA for imaging the left atrium. There was no difference in imaging quality between the two ventricles. 3DRA models of the ventricles are comparable with CT models of the ventricles. [ABSTRACT FROM AUTHOR]

Background. Catheter ablation of complex atrial arrhythmias guided by 3D models of a left atrium (LA) derived from CT/MRI or 3D rotational angiography of the heart (3DRA) is currently a common practice. Our aim is to compare radiation dose, consumption of a contrast agent and cost of these methods. Methods. From 10/2012 to 10/2015, either 3DRA (157 patients using the X-ray system Philips Allura FD 10) or computer tomography (CT) (157 patients using 64-slice CT GE Lightspeed VCT) of the LA was performed in patients undergoing complex atrial arrhythmias ablation. All procedures were monitored for average effective radiation dose, dose of the contrast agent and analysis of a financial expenditures. Results. The average effective radiation dose for 3DRA was 2.11±0.392 mSv compared to 10.52±2.093 mSv for CT. The contrast agent consumption was 22.2 mg and 48.2 mg of iodine for 3DRA and CT, respectively. Total price per procedure is 123€ for 3DRA and 161€ for CT. Conclusion. Consumption of the contrast agent and radiation burden for LA 3DRA is significantly lower in comparison to most currently used CT scan methods. Cost of both methods is comparable, however, 3DRA is slightly less expensive than CT. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to evaluate the mobility of the oesophagus and the stability of the three-dimensional (3D) model of the oesophagus using 3D rotational angiography (3DRA) of the left atrium (LA) and the oesophagus, fused with live fluoroscopy during catheter ablation for atrial fibrillation.Methods and Results: From March 2015 to September 2015, 3DRA of the LA and the oesophagus was performed in 33 patients before catheter ablation for atrial fibrillation. Control contrast oesophagography was performed every 30 min. The positions of the oesophagograms and the 3D model of the LA and the oesophagus were repeatedly measured and compared with the spine. The average shift of the oesophagus ranged from 2.7 ± 2.2 to 5.0 ± 3.5 mm. The average real-time oesophageal shift ranged from 2.7 ± 2.2 to 3.8 ± 3.4 mm. No significant shift was detected until the 90th minute of the procedure. The average shift of the 3D model of the LA and the oesophagus ranged from 1.4 ± 1.8 to 3.3 ± 3.0 mm (right-left direction) and from 0.9 ± 1.2 to 2.2 ± 1.3 mm (craniocaudal direction). During the 2 h procedure, there were no significant shifts of the model.Conclusion: During catheter ablation for atrial fibrillation, there is no significant change in the position of the oesophagus until the 90th minute of the procedure and no significant shift in the 3D model of the LA and the oesophagus. The 3D model of the oesophagus reliably depicts the position of the oesophagus during the entire procedure. [ABSTRACT FROM AUTHOR]

Aims: Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided., Methods and Results: In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0 min, median fluoroscopy time and estimated median effective dose were 240 s vs. 0 and 0.38 mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38 mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons., Conclusions: The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures., Competing Interests: Conflict of interest: N.S. and L.G. reports consulting fees from Abbott, not related to the present study., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: The objective of this study was to evaluate the mobility of the oesophagus and the stability of the three-dimensional (3D) model of the oesophagus using 3D rotational angiography (3DRA) of the left atrium (LA) and the oesophagus, fused with live fluoroscopy during catheter ablation for atrial fibrillation., Methods and Results: From March 2015 to September 2015, 3DRA of the LA and the oesophagus was performed in 33 patients before catheter ablation for atrial fibrillation. Control contrast oesophagography was performed every 30 min. The positions of the oesophagograms and the 3D model of the LA and the oesophagus were repeatedly measured and compared with the spine. The average shift of the oesophagus ranged from 2.7 ± 2.2 to 5.0 ± 3.5 mm. The average real-time oesophageal shift ranged from 2.7 ± 2.2 to 3.8 ± 3.4 mm. No significant shift was detected until the 90th minute of the procedure. The average shift of the 3D model of the LA and the oesophagus ranged from 1.4 ± 1.8 to 3.3 ± 3.0 mm (right-left direction) and from 0.9 ± 1.2 to 2.2 ± 1.3 mm (craniocaudal direction). During the 2 h procedure, there were no significant shifts of the model., Conclusion: During catheter ablation for atrial fibrillation, there is no significant change in the position of the oesophagus until the 90th minute of the procedure and no significant shift in the 3D model of the LA and the oesophagus. The 3D model of the oesophagus reliably depicts the position of the oesophagus during the entire procedure., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)