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Evaluation of a Novel Esophageal Luminal Device and its Impact on the Left Atrial-Esophageal Relationship: A Cadaveric Imaging Study
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  • Akmal Shahzad,
  • Adam Clayton,
  • Charys M. Martin,
  • Michele L. Barbeau
Akmal Shahzad
Western University Schulich School of Medicine & Dentistry

Corresponding Author:[email protected]

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Adam Clayton
Western University Schulich School of Medicine & Dentistry
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Charys M. Martin
Western University Schulich School of Medicine & Dentistry
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Michele L. Barbeau
Western University Schulich School of Medicine & Dentistry
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Abstract

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.