A novel MRI-based screening method for assessing atrio-esophageal fistula risk following cardia ablation

Atrio-esophageal fistulas affect 1 in 2000 patients who undergo cardiac ablation procedures with a mortality rate of 93%. Methods for detecting atrio-esophageal fistula formation that are objective and non-invasive could reduce the mortality associated with this disease. This study was performed retrospectively on human patients who had received a late gadolinium enhancement MRI (LGE-MRI) within 24 hours of undergoing a cardiac ablation. The study hypothesis was that image enhancement on the anterior esophageal wall following RF cardiac ablation was predictive of a patient's likelihood of developing an atrio-esophageal fistula. Presence of image enhancement on the anterior esophageal wall was compared with patient symptoms and endoscopy findings to determine if the LGE-MRI classification scheme used in the study could predict the risk that a patient would develop an atrio-esophageal fistula. Patients with more than 50% of their anterior esophageal wall showing image enhancement were found to have a higher likelihood of presenting with symptoms consistent with esophageal damage than patients with less than 50% anterior wall coverage. This method should allow physicians to more accurately detect patients who are at risk of developing an atrio-esophageal fistula and to perform therapeutic interventions.