Published Online
on September 17, 2009

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Original Article

Initial Experience of Assessing Esophageal Tissue Injury and Recovery Using Delayed-Enhancement MRI Following Atrial Fibrillation Ablation

Troy J. Badger; Yaw A. Adjei–Poku; Nathan S. Burgon; Saul Kalvaitis; Akram Shaaban; Daniel N Sommers; Joshua J.E. Blauer; Eric N. Fish; Nazem Akoum; Thomas S. Haslem; Eugene G. Kholmovski; Rob S. MacLeod; Douglas G. Adler and Nassir F. Marrouche¹

University of Utah, Salt Lake City, UT

^* Corresponding author; email: nassir.marrouche{at}hsc.utah.edu

Background—Esophageal wall thermal injury following atrial fibrillation (AF) ablaiton is a potentially serious complication. However, no noninvasive modality has been used to describe and screen patients to examine whether esophageal wall injury has occurred. We describe a noninvasive method of using delayed-enhancement MRI (DE-MRI) to detect esophageal wall injury and subsequent recovery following AF ablation.

Methods and Results—We analyzed the DE-MRI scans of 41 patients prior to ablation, and at 24 hours and 3 months post-ablation to determine whether there was evidence of contrast enhancement in the esophagus following AF ablation. In patients with contrast enhancement, three-dimensional segmentation of the esophagus was performed using a novel image processing method. Upper gastrointestinal endoscopy (UGE) was then performed. Repeat DE-MRI and UGE was performed one week later to track changes in lesions. The wall thickness of the anterior and posterior wall of the esophagus was measured at three time points; prior to ablation, 24 hours post, and 3 months post. Evaluation of pre-ablation MRI scans demonstrated no cases of esophageal enhancement. At twenty-four hours, 5 patients showed contrast enhancement. Three of these patients underwent UGE, which demonstrated esophageal lesions. Repeat UGE and MRI one week later demonstrated resolution of the lesions. All five patients had confirmed resolution of enhancement at 3 months. All patients with esophageal tissue enhancement demonstrated LA wall enhancement directly adjacent to the regions of anterior wall esophageal enhancement.

Conclusion—Our preliminary results indicate DE-MRI can assess the extent and follow progression of esophageal wall injury following catheter ablation of AF. It appears acute esophageal injury recovers within one week of the procedure.

Key Words: ablation • fibrillation • magnetic resonance imaging • atrial fibrillation • esophageal injury • upper gastrointestinal endoscopy