The Deviating the Esophagus in AF Ablation Case was performed at the Mount Sinai Hospital Electrophysiology lab and transmitted live via satellite transmission to the 2nd Annual AF Innovations Conference, held November 30 – December 1, 2012, in New York City.

The interactive case, recorded in real-time, demonstrates optimal clinical decision making strategies and procedural approaches for Deviating the Esophagus in AF Ablation.

Case History

• 60 year old male with persistent atrial fibrillation and
  atrial flutter diagnosed in 2010.
• AF associated with palpitations, dizziness, fatigue,
  and near syncope.
• Failed multiple cardioversions and antiarrhythmics (Amiodarone and Multaq)                 
• Past medical history included HTN and CAD (s/p RCA PCI)

Case Operators

Vivek Reddy, MD
Director, Cardiac Arrhythmia Service
Professor of Medicine
Mount Sinai School of Medicine
New York, NY

Srinivas Dukkipati, MD
Associate Professor of Medicine
Mount Sinai School of Medicine
New York, NY

Background - Deviating the Esophagus in AF Ablation
Catheter ablation is a commonly performed strategy employed for the treatment of atrial fibrillation. However ablation in the posterior wall of the left atrium can cause thermal injury to the esophagus.

When significant thermal injury to the esophagus occurs, two significant complications can occur: 1) the formation of an atrio-esophageal fistula, and 2) gastrointestinal dysmotility. While the former is rate, it is an important complication since it can be fatal.

Currently luminal esophageal temperature monitoring is the most commonly employed modality to prevent such injury. However, there are limitations to its use, and atrio-esophageal fistulas have been reported even when using esophageal temperature monitoring. Esophageal deviation using either a TEE or EGD probe has been described in literature, but the effectiveness and practicality of these techniques are suboptimal, and have therefore precluded their use in routine clinical practice. Recently, it has been demonstrated that esophageal deviation is indeed possible using off-the-shelf equipment (a soft thoracic tube and endotracheal stylet) in patients undergoing AF ablation.

DEVIATE-AF Trial - In this randomized single-blind study, the investigators would like to compare standard practice (i.e., use of luminal esophageal temperature monitoring) to that of esophageal deviation during AF ablation. The investigators hypothesize that the strategy of esophageal deviation will result in safer ablation strategy with a reduction in the incidence of esophageal injury as assessed by endoscopy.