Esophageal Movement Affects Ablation Strategy in a Patient with Atrial Fibrillation
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概要
- 論文の詳細を見る
A 45-year old man with drug refractory paroxysmal atrial fibrillation (AF) was admitted to our hospital for the purpose of catheter ablation (CA). Preoperative chest computed tomography 17 days previously revealed his esophagus existed at left side of vertebral. The esophagography during the procedure revealed esophagus presented at right side of his vertebral tortuously behind the right pulmonary vein (PV). Extensive encircling pulmonary vein isolation (EEPVI) using open irrigated tip catheter with CARTO system was selected for the procedure. Radiofrequency were delivered at a target power of 25–30 W for 30 seconds at each site around pulmonary veins except posterior side of right PVs (20 W) to avoid esophageal injury. All PV isolation was confirmed under isoproterenol (2γ) infusion and ATP (30 mg) bolus, and AF was not induced by left atrial burst pacing up to 2:1 atral capture. Six months later, he was admitted to our hospital to treat the recurrence of AF. On the day of RFCA 2nd session, esophagography revealed esophagus presented at left side of his vertebral. The conductions between left atrium and around right PV were re-connected. Because the esophagus did not exsist behind right PV, radiofrequency deliverly of 25–30 W could be safe and, PVs were re-isolated successfully. During the follow-up of six months, he does not suffer from AF. The esophagography in every CA session is important to decide the ablation strategy and to avoid esophageal complication.
著者
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Shimane Akira
Department of Cardiology, Himeji Cardiovascular Center
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Kanda Gaku
Department Of Cardiology Himeji Cardiovascular Center
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Shimane Akira
Department Of Cardiology Shizuoka City Hospital
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Okajima Katsunori
Department Of Applied Physics National Defence Academy
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Fukuzawa Kouji
Department Of Cardiovascular Medicine Kobe University Graduate School Of Medicine
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Hayashi Takatoshi
Department Of Applied Chemistry Faculty Of Science And Engineering Ritsumeikan University
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Teranishi Jin
Department of Cardiology, Himeji Cardiovascular Center
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Fukuzawa Kouji
Department of Cardiology, Himeji Cardiovascular Center
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