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2018 AF Symposium Live Case: The DV8 Esophageal Retractor
Background: An esophageal atrial fistula is a very rare (about one in 2,000 cases) but often deadly complication. During a catheter ablation, the esophagus, which rests next to the heart, can be injured when heat (or cold) from the catheter irritates it. The thermal damage can appear 2-3 weeks after the ablation when a hole forms between the atrium and the esophagus. This weakened area of the esophagus can be eaten through by acid reflex with deadly consequences.
Live Streaming Video at AF Symposium
Demonstrated during a live presentation via streaming video, the DV8 Retractor from Manual Surgical Sciences could eliminate the danger of esophageal atrial fistula. The DV8 Retractor is an inflatable balloon retractor system that moves the esophagus away from the site of ablation.
Drs. Kevin Heist, Conor Barrett and Moussa Mansour from Massachusetts General in Boston, MA demonstrated this simple, effective way of protecting the Esophagus from thermal injury during an ablation.
We watched as Dr. Heist and his colleagues inserted what looked like a thin straight silicon tube into the patient’s esophagus. (The esophagus is a flexible structure and moves naturally.) They then inflated the device which formed a bend or loop and pushed the esophagus as much as 40 mm away from the ablation site. The device could also be maneuvered up and down to further increase the deflection from the ablation site.
DV8 Retractor from Manual Surgical Sciences : Uninflated (L), Inflated (R).
The device has two ports―one for balloon inflation/deflation and a separate one for contrast injection into the esophagus to check placement.
Dr. Mansour stressed that this device should be used in all ablations. Even though esophageal fistula is a very rare complication (around one in 2,000 cases), there is now no reason for the esophagus to ever be damaged during an ablation.
Editor’s comments: Unfortunately there is no way to require EPs to learn about and used this device.
What this means to patients: If you are having an ablation, make sure your center and EP have and use this or another esophageal protection device. If they don’t, you shouldn’t proceed. You MUST go elsewhere where they do!!! It makes no sense to risk an esophageal injury when it is so easily prevented.
If you find any errors on this page, email us. Y Last updated: Tuesday, February 18, 2020
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