Images in cardiovascular medicine. Esophageal diverticulum illustrated by barium swallow during left atrial catheter ablation for atrial fibrillation.

Left atrial radiofrequency catheter ablation guided by a 3-dimensional electroanatomic mapping system (CARTO, Biosense-Webster, Diamond Bar, Calif) was performed in a 67-year-old woman with paroxysmal atrial fibrillation. To avoid delivery of radiofrequency energy near the esophagus, the patient was asked to swallow 5 cm of barium paste (E-Z-EM, Lake Success, NY) before conscious sedation, as described previously.1 The esophagram delineated a previously undiagnosed esophageal diverticulum (Figure 1). The location of the esophagus relative to the posterior wall of the left atrium was tagged on the electroanatomic map (Figure 2). The diverticulum was 20 mm long and 17 mm wide. This case illustrates the importance of the complete visualization of the esophageal lumen during a left atrial ablation procedure and demonstrates the limitations of using an esophageal probe to monitor the position of the esophagus. If barium paste had not been swallowed, radiofrequency energy may have been delivered unknowingly over the diverticulum, putting the patient at risk of esophageal injury and atrioesophageal fistula.2