Further evidence of a close anatomical relation between the oesophagus and pulmonary veins

Atrio-oesophageal fistula has been reported as a rare but life-threatening complication of ablation of atrial fibrillation (AF). Therefore, the position of the oesophagus in relation to the left atrium (LA) is of major importance for AF ablation.

In order to investigate the possible anatomical variability between the oesophagus and the left atrium, multidetector-row spiral computed tomography (MDCT) of 60 healthy males (age 58.1 ± 5.1 years; LA diameter 5.4 ± 0.7 × 3.8 ± 0.6 cm; LA volume 60.5 ± 15.4 ml) was analyzed. The distance between the oesophagus and the ostia of the pulmonary veins (PV) ranged between 0 and 50.7 mm. Especially for the left PV, the oesophagus was closer than 5 mm to the ostia in 29 cases (48%; n = 24 for left superior PV; n = 10 for left inferior PV; n = 0 for right superior PV; n = 1 for right inferior PV). In addition, the oesophagus was very close to the LA wall (0.8 ± 0.9 mm; range 0–3.3 mm). Intraobserver variability was 1.1 ± 0.7 mm or 3.5%.

The position of the oesophagus in relation to the LA and the PV demonstrates high variability. In many cases, the oesophagus is very close to the ostia of the PVs and lies only a short distance from the LA wall. Thus, an anatomical localization of the oesophagus may be critical before or during AF ablation to prevent atrio-oesophageal fistula, especially as there is a need for transmural atrial lesions.