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Bautista JAL, Liu CM, Ibrahim AE, Lo LW, Chung FP, Hu YF, Chang SL, Lin YJ, Lin CY, Chang TY, Kuo L, Liu SH, Cheng WH, Chen WT, Kao PH, Kuo MJ, Nguyen-Khac TC, Li GY, Lin CH, Huang YS, Wu SJ, Siow YK, Son Nguyen ND, Tran DC, Chen SA. Impact of proximity of left atrium to descending aorta on left inferior pulmonary vein triggers or drivers of atrial fibrillation: A risk score model. Heart Rhythm 2024:S1547-5271(24)02881-9. [PMID: 38997056 DOI: 10.1016/j.hrthm.2024.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/16/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Prior studies have investigated cardiac anatomy and clinical parameters as predictors for pulmonary vein and non-pulmonary vein triggers. OBJECTIVE We aimed to assess the link between the descending aorta to left inferior pulmonary vein (Dao-LIPV) distance and the occurrence of triggers and drivers in atrial fibrillation (AF) ablation procedures. METHODS Drug-refractory AF patients who underwent first-time index catheter ablation from January 2010 to December 2019 were retrospectively assembled. The Dao-LIPV distance was measured from preablation pulmonary vein computed tomography. Patients were assigned to groups on the basis of the presence of LIPV triggers or drivers. Multivariate logistic regression was used to identify risk factors. RESULTS A total of 886 consecutive patients with drug-refractory AF were studied, and 63 (7.1%) patients were identified to have LIPV triggers or drivers. The Dao-LIPV distance had a better predictive performance (area under the curve, 0.70) compared with persistent AF (area under the curve, 0.57). Multivariate logistic regression analysis showed that Dao-LIPV distance ≤2.5 mm (odds ratio, 3.96; 95% CI, 2.15-7.29; P < .001) and persistent AF (odds ratio, 1.73; 95% CI, 1.02-2.94]; P = .044) were independent predictors for the presence of LIPV triggers or drivers. A risk score model was established to predict the probability of LIPV triggers or drivers with persistent AF (10.2%), Dao-LIPV distance ≤2.5 mm (11.4%), and both (15.0%). CONCLUSION The proximity of the Dao-LIPV was correlated to the presence of LIPV triggers or drivers. We developed a risk score model indicating that persistent AF and Dao-LIPV distances ≤2.5 mm significantly increase the risk of LIPV triggers or drivers, aiding electrophysiologists in preparing for and performing catheter ablation more effectively.
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Affiliation(s)
- Jose Antonio L Bautista
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Section of Clinical Cardiac Electrophysiology, Heart Institute, St Luke's Medical Center-Global City, Taguig City, Philippines
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ahliah E Ibrahim
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Section of Clinical Cardiac Electrophysiology, Heart Institute, St Luke's Medical Center-Global City, Taguig City, Philippines
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Tso Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Heng Kao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Jen Kuo
- Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Thien-Chuong Nguyen-Khac
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Guan-Yi Li
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Hsien Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Shan Huang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shang-Ju Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yoon Kee Siow
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Cardiology, Serdang Hospital, Selangor, Malaysia
| | - Ngoc Dinh Son Nguyen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; University Medical Center, Ho Chi Minh City, Vietnam
| | - Dat Cao Tran
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan.
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2
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Grosse Meininghaus D, Freund R, Koerber B, Kleemann T, Matthes H, Geller JC. Pulsed-field ablation does not induce esophageal and periesophageal injury-A new esophageal safety paradigm in catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:86-93. [PMID: 37975544 DOI: 10.1111/jce.16132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non-thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio-esophageal fistula (AEF). OBJECTIVE To compare the incidence of any (peri)-esophageal injury following PVI using PFA to thermic energy sources. METHODS Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)- or cryoballoon (CB)-PVI. RESULTS Between December 2022 and February 2023, 20 patients (67 ± 10 years, 53% male) undergoing PFA (Farapulse, Boston Scientific) for atrial fibrillation (AF) were studied and compared with a previous cohort of 57 patients who underwent thermic PVI (CB: n = 33; RF: n = 24). Following PFA-PVI, none of the patients had mucosal lesions, food retention, or ablation-induced vagal nerve injury; four patients showed periesophageal edema. Following thermic ablation, 33/57 patients (58%) showed esophageal and/or periesophageal injury (CB: 21/33 [64%], RF: 12/24 [50%]), in detail 4/57 mucosal lesions, 18/57 food retention, 17/57 vagal nerve injury, and 20/52 edema. Midterm success rates were similar for all energy sources. CONCLUSION In contrast to thermic ablation tools, PFA is not associated with relevant esophageal and periesophageal injury, and might, therefore, reduce or eliminate the risk of potentially lethal AEF in interventional treatment of AF. The etiology of ablation-induced periesophageal edema is unknown but has not been shown to be related to lesion progression.
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Affiliation(s)
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Britta Koerber
- Division of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Tobias Kleemann
- Division of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Harald Matthes
- Division of Gastroenterology, Community-Hospital Havelhoehe Berlin, Berlin, Germany
| | - Johann Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
- Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
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3
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Hayashi T, Murakami M, Saito S, Iwasaki K. Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT. Open Heart 2022; 9:openhrt-2021-001724. [PMID: 34992156 PMCID: PMC8739445 DOI: 10.1136/openhrt-2021-001724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
Background The limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon. Method A systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included ‘atrial fibrillation’, ‘cryoballoon ablation’ and ‘anatomy’. Results Overall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury. Conclusion This study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.
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Affiliation(s)
- Takahiro Hayashi
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, Shinjuku-ku, Tokyo, Japan.,Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Masato Murakami
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, Shinjuku-ku, Tokyo, Japan
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4
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Kaneshiro T, Takeishi Y. Esophageal thermal injury in catheter ablation of atrial fibrillation. Fukushima J Med Sci 2021; 67:95-101. [PMID: 34803083 PMCID: PMC8784191 DOI: 10.5387/fms.2021-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary vein isolation is an established method for the catheter ablation of atrial fibrillation. Esophageal thermal injuries, such as esophageal erosion, ulceration and periesophageal nerve injury leading to gastric hypomotility, are important complications associated with pulmonary vein isolation. In this review article, we describe the mechanisms, characteristics and the predictors of esophageal thermal injury associated with pulmonary vein isolation.
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Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine/Arrhythmia and Cardiac Pacing, Fukushima Medical University
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine/Arrhythmia and Cardiac Pacing, Fukushima Medical University
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5
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Therapeutic approach of adipose-derived mesenchymal stem cells in refractory peptic ulcer. Stem Cell Res Ther 2021; 12:515. [PMID: 34565461 PMCID: PMC8474857 DOI: 10.1186/s13287-021-02584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022] Open
Abstract
Peptic ulcer is one of the most common gastrointestinal tract disorders worldwide, associated with challenges such as refractory morbidity, bleeding, interference with use of anticoagulants, and potential side effects associated with long-term use of proton pump inhibitors. A peptic ulcer is a defect in gastric or duodenal mucosa extending from muscularis mucosa to deeper layers of the stomach wall. In most cases, ulcers respond to standard treatments. However, in some people, peptic ulcer becomes resistant to conventional treatment or recurs after initially successful therapy. Therefore, new and safe treatments, including the use of stem cells, are highly favored for these patients. Adipose-derived mesenchymal stem cells are readily available in large quantities with minimal invasive intervention, and isolation of adipose-derived mesenchymal stromal stem cells (ASC) produces large amounts of stem cells, which are essential for cell-based and restorative therapies. These cells have high flexibility and can differentiate into several types of cells in vitro. This article will investigate the effects and possible mechanisms and signaling pathways of adipose tissue-derived mesenchymal stem cells in patients with refractory peptic ulcers.
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6
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Molenaar MMD, Hesselink T, Scholten MF, Kraaier K, Bouman DE, Brusse-Keizer M, Stevenhagen YJ, van Dessel PFHM, Ten Haken B, Grandjean JG, van Opstal JM. High incidence of (ultra)low oesophageal temperatures during cryoballoon pulmonary vein isolation for atrial fibrillation. Neth Heart J 2020; 28:662-669. [PMID: 33170441 PMCID: PMC7683692 DOI: 10.1007/s12471-020-01493-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Low oesophageal temperatures (OTs) during cryoballoon pulmonary vein isolation (PVI) have been associated with complications. This study assessed the incidence of low OT in clinical practice during cryoballoon PVI and verified possible predictive values for low OT. Methods Consecutive patients who underwent PVI using the second-generation cryoballoon were retrospectively included. The distance from the oesophagus to the different pulmonary veins (PVs) (OP distance), body mass index (BMI), sex, age, balloon temperature and application time were studied as potential predictors of low OTs. Computed tomography was performed before the procedure to determine the OP distance. OT was measured using an oesophageal temperature probe. Applications were ended prematurely if the OT reached <16 °C. Low and ultralow OT were defined as OT <20 and <16 °C respectively. Results Two hundred and four patients were included. Low OT was observed in 54 patients (26%) and 27 patients (13%) reached ultralow OTs. OP distance was the only predictor of low OTs after multivariate analysis. A cut-off value of 19 mm showed 96.2% sensitivity and 37.8% specificity in predicting low OTs. No clinically relevant relation was found between low OTs and BMI, age, sex, balloon temperature or application duration. Conclusions The incidence of low OT was 26% for cryoballoon PVI. OP distance was the only predictor of low OTs. Since an OP distance <19 mm was present in all patients in at least one PV, we recommend routine OT measurement during PVI cryoballoon therapy to prevent oesophagus-related complications.
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Affiliation(s)
- M M D Molenaar
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands. .,Department of Magnetic Detection and Interventions, University of Twente, Enschede, The Netherlands.
| | - T Hesselink
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M F Scholten
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K Kraaier
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - D E Bouman
- Radiology Department, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Y J Stevenhagen
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - B Ten Haken
- Department of Magnetic Detection and Interventions, University of Twente, Enschede, The Netherlands
| | - J G Grandjean
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J M van Opstal
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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7
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Assis FR, Shah R, Narasimhan B, Ambadipudi S, Bhambhani H, Catanzaro JN, Calkins H, Tandri H. Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies. J Cardiovasc Electrophysiol 2020; 31:1364-1376. [PMID: 32323383 DOI: 10.1111/jce.14513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 01/19/2023]
Abstract
Catheter ablation has become an important element in the management of atrial fibrillation. Several technical advances allowed for better safety profiles and lower recurrence rates, leading to an increasing number of ablations worldwide. Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton-pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted. Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rushil Shah
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bharat Narasimhan
- Department of Internal Medicine, Mount Sinai St. Lukes-Roosevelt, New York, New York
| | - Sravya Ambadipudi
- Department of Medicine, Division of Cardiology, Purdue University College of Pharmacy, West Lafayete, Indiana
| | - Hrithika Bhambhani
- Department of Biological Sciences, University of Southern California, Los Angeles, California
| | - John N Catanzaro
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Overestimation and Underweighting of Rare Events. JACC Clin Electrophysiol 2020; 6:269-271. [DOI: 10.1016/j.jacep.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 11/20/2022]
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9
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Kaneshiro T, Hijioka N, Matsumoto Y, Nodera M, Yamada S, Kamioka M, Takeishi Y. Temperature drop in thawing phase reflects sufficient ice formation and better outcome of pulmonary vein isolation using second-generation cryoballoon. J Interv Card Electrophysiol 2019; 59:357-364. [PMID: 31773450 DOI: 10.1007/s10840-019-00659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few reports exist regarding the details of ice formation on second-generation cryoballoon (CB) surface during pulmonary vein isolation (PVI). We propose a new parameter "temperature drop" in thawing phase for predicting sufficient ice formation and CB-PVI outcome. METHODS Consecutive 106 patients who underwent successful CB-PVI for atrial fibrillation (AF) were analyzed. We defined "temperature drop" as a temperature drop of more than 3 °C just after CB catheter bending. We compared the previously known parameters predicting durable PVI between PVs with or without temperature drop. Then, we compared the PVI outcome among three groups: group 1 with temperature drop in all PVs, group 2 with temperature drop in 1-3 PVs, and group 3 without temperature drop in any PV. RESULTS Temperature drop was present in 206 out of 424 isolated PVs. In those, PV occlusion score was significantly higher (3.7 ± 0.5 vs. 3.5 ± 0.6, P <0.001), and thawing time was significantly longer (55 ± 20 vs. 46 ± 21 s, P < 0.001) in PVs with temperature drop than those without. With a mean follow up period of 376 ± 217 days, Kaplan-Meier survival analysis revealed that no patients in group 1 experienced AF recurrence, 14 out of 86 patients (16%) experienced AF recurrence in group 2, and 5 out of 10 (50%) patients experienced AF recurrence in group 3 (Log-Rank P = 0.003). CONCLUSION The temperature drop in thawing phase might reflect the state of ice formation and can be used to predict clinical outcome after CB-PVI.
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Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan.
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yoshiyuki Matsumoto
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
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Giaretto V, Ballatore A, Passerone C, Desalvo P, Matta M, Saglietto A, De Salve M, Gaita F, Panella B, Anselmino M. Thermodynamic properties of atrial fibrillation cryoablation: a model-based approach to improve knowledge on energy delivery. J R Soc Interface 2019; 16:20190318. [PMID: 31530136 DOI: 10.1098/rsif.2019.0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objective of this study is to describe a suitable model of atrial fibrillation cryoablation thermodynamic properties. Three different thermal loads were applied to a cylindrical copper element simulating the cryoprobe, thermally coupled with a Peltier stack producing the freezing effect, and in contact with a bovine liver sample. Thermal events occurring inside the samples were measured using mirror image technique. Heat subtracted flux during ice formation and minimum temperature measured at probe-tissue interface were, respectively, 1.33 W cm-2 and -27.8°C for Sample#0, 1.88 W cm-2 and -35.6°C for Sample#1 and 1.82 W cm-2 and 1.44 W cm-2 before and after the ice trigger, respectively, and -29.3°C for Sample#2. Ice trigger temperature was around -8.5°C for Sample#0 and Sample#2, and -10.4°C for Sample#1. In all the investigated samples, ice front penetration was proportional to the square root of time and its velocity depended on the heat flux subtracted. The fraction of the useful energy spent for ice formation was less than 60% for Sample#0, and about 80% for Sample#1 and for Sample#2, before the reduction of the removed heat flux. Freezing time exceeding a cut-off, according to the heat subtracted flux, does not improve the procedure effectiveness and is detrimental to the surrounding tissues.
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Affiliation(s)
| | - Andrea Ballatore
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Passerone
- Department of Electronics and Telecommunications, Politecnico di Torino, Italy
| | - Paolo Desalvo
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Matta
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Fiorenzo Gaita
- Department of Cardiology, Clinica Pinna Pintor, Turin, Italy
| | | | - Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
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