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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]