Evaluation of a Novel Esophageal Luminal Device and its Impact on the
Left Atrial-Esophageal Relationship: A Cadaveric Imaging Study
Background: Atrial-esophageal fistula (AEF) is a complication
of catheter ablation procedures for atrial fibrillation. Esophageal
luminal devices (ELDs) may potentially mitigate the risk of developing
an AEF by preventing thermal injury, yet their impact on the
esophagus-left atrium (LA) relationship is unknown. Objective:
This study will investigate the changes, if any, that occur in the
LA-esophageal relationship upon insertion of an ELD prototype.
Methods: Twelve fresh cadaveric torsos were scanned, via
computed tomography (CT), with and without an ELD. Esophageal width and
anterior-posterior dimension (APD) were digitally measured and compared
within specimens. 3D reconstructions of the LA and esophagus were used
for a spatial analysis of their relationship. Translational movements of
the esophagus were also noted from reconstructions.
Results: Minimal esophageal translation was noted in seven
(58%) specimens, leftwards deviation in three (25%) specimens, and
posterior deviation in two (17%) specimens. One or both of esophageal
width and APD increased in eleven (92%) specimens but did not always
lead to an increase in surface contact at the posterior LA. In addition,
leftwards or posterior deviation of the esophagus was associated with a
reduction in surface contact, with the latter reducing contact
completely. Furthermore, the anterior esophagus-LA distance was a good
predictor of surface contact changes. Conclusions: This study
is the first to provide a comprehensive understanding of changes in the
esophagus-LA relationship as it pertains to the use of ELDs.
Heterogeneity in morphological and translational changes of the
esophagus suggest the need for considering anatomical variations in the
design of medical devices.