caa a22 4500 44579481X CHVBK 20180317145121.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s10620-011-1829-1 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1829-1 Cross-Sectional Imaging Obtained Immediately Following Radiofrequency Atrial Fibrillation Ablation Does Not Predict Endoscopic Evidence of Esophageal Injury [Elektronische Daten] [Darcie Gorman, Kathryn Peterson, John Fang, Jeffrey Olpin, Daniel Sommers, Molly McFadden, Jack Morshedzadeh, Nazem Akoum, Marcos Daccarett, Nassir Marrouche, Douglas Adler] Background: Radiofrequency atrial fibrillation ablation (AFA) is commonly performed in patients with atrial fibrillation. It is imperative to develop a strategy for the early detection of esophageal lesions secondary to AFA. The current protocol is to obtain cross-sectional imaging before and immediately after the procedure. If patients have evidence of esophageal inflammation, they undergo esophagogastroduodenoscopy (EGD). We hypothesized that esophageal abnormalities seen on imaging immediately post-ablation are a poor predictor of the damage seen during EGD. Methods: Patients referred for EGD following AFA from 1/2009 to 11/2010 were included. Two endoscopists reviewed and scored the EGD images. Two radiologists reviewed the post-AFA imaging studies. For computed tomography (CT) scans, esophageal inflammation was scored from 0 to 2. For T2 and delayed magnetic resonance imaging (MRI) pictures, esophageal enhancement was scored from 0 to 2, with the circumference involved as 0, <50%, or >50%, and the length of esophageal enhancement in mm. Results: In total, 76 patients were included; 22 patients had only endoscopic images and 54 had both endoscopic and radiologic images for review. Of the post-AFA imaging studies, 16 were CTs and 60 were MRIs. The kappa score for the inter-rater agreement of esophageal inflammation on EGD was 0.4584 (moderate). For MRIs, the kappa scores for T2 images were 0.1980 and 0.2857 for edema and circumference, respectively. For delayed images, the kappa scores were 0.2687 and 0.3101 for edema and circumference, respectively. The kappa scores were negative between EGD score by T2 edema (−0.2104) and circumference (−0.2212), and between EGD score and delayed edema (−0.0588) and circumference (−0.0446). When measures were treated as dichotomous, the overall agreement between CT measures and EGD scores was kappa=0, for T2 measures and EGD kappa=−0.2963, 95% confidence interval (CI) (−0.5643, −0.0282), and between delayed measures kappa=−0.0244, 95% CI (−0.1420, −0.0932). Conclusions: There was no agreement between immediate imaging and the endoscopic findings of esophageal inflammation after AFA. A longer period of time between AFA and obtaining an imaging study may be useful in detecting patients with significant esophageal injury who should undergo EGD to assess for complications of AFA. Further studies are needed in order to determine the best modalities and optimal timing to detect post-AFA esophageal damage in an attempt to prevent the formation of atrial-esophageal fistulas. Springer Science+Business Media, LLC, 2011 Esophageal nationallicence Atrial fibrillation nationallicence Atrial-esophageal fistula nationallicence Endoscopy nationallicence Ablation nationallicence Imaging nationallicence CT nationallicence MRI nationallicence Gorman Darcie Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut Peterson Kathryn Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut Fang John Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut Olpin Jeffrey Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut Sommers Daniel Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut McFadden Molly Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA aut Morshedzadeh Jack Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut Akoum Nazem Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut Daccarett Marcos Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut Marrouche Nassir Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut Adler Douglas Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3453-3458 0163-2116 56:12<3453 2011 56 10620 https://doi.org/10.1007/s10620-011-1829-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1829-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Gorman Darcie Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Peterson Kathryn Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Fang John Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Olpin Jeffrey Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Sommers Daniel Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- McFadden Molly Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Morshedzadeh Jack Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Akoum Nazem Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Daccarett Marcos Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Marrouche Nassir Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA aut NATIONALLICENCE 700 1- Adler Douglas Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, 84132, Salt Lake City, UT, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3453-3458 0163-2116 56:12<3453 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer