Europace Advance Access originally published online on September 5, 2007
Europace 2007 9(10):931; doi:10.1093/europace/eum187
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ABLATION
Persistent barium sulphate oesophagus opacification while pulmonary veins ablation
Dipartimento di Cardiologia, Ospedale Civile Mirano, Venice, Italy
Manuscript submitted 1 July 2007. Accepted after revision 3 August 2007.
* Corresponding author. Tel: +39 03472721990. E-mail address: francozoppo{at}vodafone.it
Key Words: Barium oesophagus opacification, Left atrium ablation
Pulmonary veins (PV) isolation is clearly deemed as the key point for the cure of atrial fibrillation. In order to reach permanent PV deconnection, a high amount of radiofrequency energy is often required. One of the most feared complications of such treatment is the development of atrio-oesophageal fistula, which is considered the most dangerous life-threatening adverse event. The visualization of the oesophagus is possible using a preablation CT or MR scan, which offer a non-real-time imaging and by means of endo-oesophageal temperature monitoring, or electroanatomic oesophagus mapping which offer real-time informations. We propose a simple but reliable tool to persistent opacification of the oesophagus while PV ablation using a dedicated barium sulphate suspension.
The preparation (ProntoBario, Bracco, via Folli 50, Milano, Italy) seeks to combine a good suspension of the barium sulphate with good adherence to the X-rayed oesophagus wall. The preparation is characterized by an aqueous gel of cellulose and an aqueous vehicle, incorporating the resultant gel into screened colloidal barium sulphate. The mixture is homogenized and the pH adjusted to 8. The pharmaceutical preparations are specifically for oral administration. Even though there is a inter-individual variability that characterizes the clearance of the oesophagus bolus and consequently the visualization, even due to different autonomic tone, which alter the peristaltic gastrooesophageal movements, the advantage of the gel administration is its delayed clearance while swallowing, warranting the late visualization during the whole procedure.
In Figure 1, a standard left atrium fluoroscopy image is displayed, with standard catheter instrumentation for a PV ablation. The late clearance of barium paste allows late visualization of the oesophagus high contrast shadow from the beginning of procedure till the end, when a late ‘ghost’ of such structure is still visible.
The preparation taste is very well tolerated by the patients and in our opinion might be considered a helpful additive tool while organizing a PV ablation equipment.
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Conflict of interest: none declared.
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