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Shigeta T, Miyazaki S, Inaba O, Inamura Y, Nitta J, Sekiguchi Y, Takahashi A, Hachiya H, Nagata Y, Yamauchi Y, Hayashi T, Iwai S, Mizukami A, Ono Y, Handa K, Suzuki M, Suzuki A, Nakajima J, Hirao K, Okada H, Negishi M, Ikenouchi T, Yamamoto T, Goto K, Nishimura T, Tao S, Takigawa M, Hirakawa A, Goya M, Sasano T. Adjunctive posterior wall isolation for the treatment of persistent and longstanding persistent atrial fibrillation (CORNERSTONE AF) trial: Design and rationale. Clin Cardiol 2024; 47:e24164. [PMID: 37822107 PMCID: PMC10766127 DOI: 10.1002/clc.24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A left atrial posterior wall isolation (LAPWI) is one of the atrial fibrillation (AF) ablation strategies. HYPOTHESIS We hypothesized that an additional empirical LAPWI would increase the freedom from recurrent atrial arrhythmias as compared to standard AF ablation in persistent AF patients. METHODS The CORNERSTONE AF study is a prospective, randomized, multicenter study investigating patients with AF persisting for >7 days and <3 years undergoing first-time AF ablation. They will be randomized to pulmonary vein isolation (PVI) or PVI + LAPWI in a 1:1 manner. Although PVI can be performed with either radiofrequency catheters or cryoballoons, only radiofrequency catheters will be permitted to achieve LAPWIs. Additional focal ablation targeting non-pulmonary vein triggers will be allowed. A total of 516 patients will be enrolled in 17 centers between August 2022 and February 2024 based on the calculation with 80% power, considering the assumption that 65% and 75% of the PVI and PVI + LAPWI group patients will be free from atrial arrhythmia recurrence 18-months postprocedure (10% of dropout). The primary endpoint is freedom from documented atrial arrhythmias 18 months postsingle procedures. Clinical follow-up will include 7-day ambulatory electrocardiograms and routine outpatient consultations by electrophysiologists at 1, 3, 6, 9, 12, and 18 months postprocedure. RESULTS As of August 2023, a total of 331 patients (68 ± 9 years, 270 men, 43 longstanding persistent AF) have been enrolled. CONCLUSIONS The CORNERSTONE AF study is a prospective, randomized, multicenter trial designed to evaluate the efficacy and safety of an adjunctive empirical LAPWI following standard AF ablation in persistent AF patients.
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Affiliation(s)
- Takatoshi Shigeta
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Osamu Inaba
- Department of CardiologyJapanese Red Cross Saitama HospitalSaitamaJapan
| | - Yukihiro Inamura
- Department of CardiologyJapanese Red Cross Saitama HospitalSaitamaJapan
| | - Junichi Nitta
- Department of CardiologySakakibara Heart InstituteTokyoJapan
| | - Yukio Sekiguchi
- Department of CardiologySakakibara Heart InstituteTokyoJapan
| | | | | | - Yasutoshi Nagata
- Department of CardiologyJapanese Red Cross Musashino HospitalTokyoJapan
| | - Yasuteru Yamauchi
- Department of CardiologyJapanese Red Cross Yokohama City Bay HospitalKanagawaJapan
| | - Tatsuya Hayashi
- Division of Cardiovascular Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Shinsuke Iwai
- Department of CardiologyHiratsuka Kyosai HospitalKanagawaJapan
| | | | - Yuichi Ono
- Department of CardiologyOme Municipal General HospitalTokyoJapan
| | - Keita Handa
- Division of CardiologyKashiwa City HospitalChibaJapan
| | - Makoto Suzuki
- Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
| | | | - Jun Nakajima
- Department of CardiologyTokyo Metropolitan Toshima HospitalTokyoJapan
| | - Kenzo Hirao
- Arrhythmia Advanced Therapy CenterAOI Universal HospitalKanagawaJapan
| | - Hiroyuki Okada
- Department of CardiologySoka Municipal HospitalSaitamaJapan
| | - Miho Negishi
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Takashi Ikenouchi
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tasuku Yamamoto
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kentaro Goto
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Takuro Nishimura
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Susumu Tao
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Masateru Takigawa
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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Abdulsalam NM, Sridhar AM, Tregoning DM, He BJ, Jafarvand M, Mehri A, Afroze T, Chahine Y, Ko CW, Akoum N. Esophageal luminal temperature monitoring using a multi-sensor probe lowers the risk of esophageal injury in cryo and radiofrequency catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2023; 66:1827-1835. [PMID: 36745324 DOI: 10.1007/s10840-023-01492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal luminal temperature monitoring is a commonly used strategy to reduce esophageal thermal injury in catheter ablation for atrial fibrillation (AFib). OBJECTIVES We sought to compare the incidence of endoscopically detected esophageal lesions (EDEL) between two commonly used esophageal luminal temperature probes. METHODS Consecutive patients undergoing ablation with esophageal luminal temperature monitoring and upper endoscopy within 24 h after ablation were included. RESULTS Four hundred forty-five patients (64 ± 10 years, 44% female) were included. Esophageal temperature monitoring was done with a single-sensor probe in 213 (48%) and multi-sensor probe in 232 (52%). Cryoballoon (CB) ablation was performed in 118 (27%) and radiofrequency (RF) ablation in 327 (73%) of patients. EDEL was present in 94 (22.9%) of which 85 were mild, 8 were moderate, and 1 was severe, and none progressed to atrial-esophageal fistula. The use of the multi-sensor probe during CB ablation was associated with a reduction in EDEL compared to single sensor (6.8% vs 24.3%; P = 0.016). Similarly, in the RF ablation group, EDEL was present in 19.5% of the multi-sensor group vs 32.8% in the single-sensor group (P = 0.001). Logistic regression showed that multi-sensor probe use was associated with reduction in EDEL with an odds ratio of 0.23 in CB ablation (P = 0.024) and 0.44 for RF ablation (P = 0.001). CONCLUSIONS Esophageal luminal temperature monitoring during AFib ablation using a multi-sensor probe was associated with a significant reduction in EDEL compared to a single-sensor probe.
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Affiliation(s)
- Nashwa M Abdulsalam
- Division of Cardiology, PeaceHealth Southwest Medical Center, 400 NE Mother Jospeh PI, WA, 98664, Vancouver, USA.
| | - Arun M Sridhar
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Deanna M Tregoning
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Beixin J He
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Mahbod Jafarvand
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Avin Mehri
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Tanzina Afroze
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Yaacoub Chahine
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Cynthia W Ko
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Nazem Akoum
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
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Khoshknab M, Zghaib T, Xu L, Arkles J, Santangeli P, Marchlinski FE, Han Y, Desjardins B, Nazarian S. Esophageal image segmentation for guidance of posterior wall lesions during atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 65:543-550. [PMID: 35856123 DOI: 10.1007/s10840-022-01307-9] [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: 12/04/2021] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without image segmentation for esophageal visualization (EV). METHODS The retrospective cohort included 73 patients (mean age 65.2 ± 8.6 years, 36% female, 55% paroxysmal AF) who underwent pre-procedural cardiac magnetic resonance or computed tomography and LET monitoring. Of all patients, 35 were historical patients that underwent standard AF ablation without EV, and 38 were contemporary patients, 28 of whom underwent AF ablation with EV and 10 that underwent AF ablation without EV. RESULTS Total RF time was similar between the groups. The distribution of ablation power delivery was skewed toward higher power in the contemporary patients. However, among patients in the contemporary group, the proportion of > 35 Watts lesions was lower with EV (P < 0.001). There was no difference between the max or mean LET. The standard deviation of LET change within patient during posterior wall ablation was lower in those with esophageal visualization compared to historical controls, but no change was seen compared to a smaller group of contemporary controls. No long-term clinical esophageal injury was observed. CONCLUSIONS In a retrospective analysis, EV was successfully performed in 28 patients. EV impacted RF power delivery decisions but was unassociated with RF time, changes in LET, or long-term safety.
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Affiliation(s)
- Mirmilad Khoshknab
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Tarek Zghaib
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Lingyu Xu
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Arkles
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Pasquale Santangeli
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Francis E Marchlinski
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Yuchi Han
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Benoit Desjardins
- Radiology Department, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Saman Nazarian
- Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
- University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Founders 9118, Philadelphia, PA, 19104, USA.
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Arai S, Watanabe N, Sugiyama H, Gokan T, Yoshikawa K, Nakamura Y, Inokuchi K, Chiba Y, Onishi Y, Onuki T, Asano T, Kobayashi Y, Shinke T. Esophageal thermal lesions in radiofrequency ablation for atrial fibrillation: A prospective comparative study of thermal sensors. Pacing Clin Electrophysiol 2022; 45:913-921. [PMID: 35694969 DOI: 10.1111/pace.14551] [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: 03/27/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Esophageal thermal lesion (ETL) is a complication of radiofrequency ablation for atrial fibrillation (RFAF). To prospectively compare the incidence of ETL, we used two linear, five- and three-sensor esophageal thermal monitoring catheters (ETMC5 and ETMC3). We also evaluated the predictors of ETL. METHODS Patients receiving their first RFAF (n = 106) were randomized into two groups, ETMC5 (n = 52) and ETMC3 (n = 54). Ablation was followed by esophagogastroduodenoscopy within 3 days. RESULTS Esophageal thermal lesion was detected in 7/106 (6.6%) patients (ETMC5: 3/52 [5.8%] vs. ETMC3: 4/54 [7.4%]; p = 1.0). The maximum temperature and number of measurements > 39.0°C did not differ between the groups (ETMC5: 40.5°C and 5.4 vs. ETMC3: 40.6°C and 4.9; p = .83 and p = .58, respectively). In ETMC5 group, the catheter had to be moved significantly less often (0.12 vs. 0.42; p = .0014) and fluoroscopy time was significantly shorter (79.2 min vs. 101.7 min; p = .0038) compared with ECMC3 group. The total number of ablations in ETMC5 group was significantly greater (50.2 vs. 37.7; p = .030) and ablation time was significantly longer (52.1 min vs. 40.1 min; p = .0039). Only body mass index (BMI) was significantly different between patients with and without ETL (21.4 ± 2.5 vs. 24.3 ± 3.4; p = .022). CONCLUSIONS The incidence of ETL was comparable between ETMC5 and ETMC3 groups; however, fluoroscopy time, total ablation time, and total number of ablations differed significantly. Lower BMI may increase the risk of developing ETL.
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Affiliation(s)
- Shuhei Arai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Norikazu Watanabe
- Department of Cardiovascular Medicine, Kanto Rosai Hospital, Kawasaki, Japan
| | - Hiroto Sugiyama
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiko Gokan
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kosuke Yoshikawa
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuya Nakamura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Koichiro Inokuchi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Chiba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimi Onishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Onuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Taku Asano
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Kronenberger R, Van Loo I, de Asmundis C, Aerts M, Gelsomino S, Umbrain V, Chierchia GB, La Meir M. Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation. J Clin Med 2021; 10:jcm10214981. [PMID: 34768501 PMCID: PMC8584802 DOI: 10.3390/jcm10214981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The development of an atrio-esophageal fistula, a rare yet potentially lethal complication of ablation for atrial fibrillation, could be related to direct tissue heat transfer during and immediately after the ablation. We therefore studied the postoperative esophageal findings by esophagogastroduodenoscopy in patients that underwent a hybrid ablation procedure using a novel preventive strategy to avoid thermal lesions. Methods Thirty-four patients (28 males; 65 years ± 9 years) were retrospectively included. All underwent a hybrid ablation in our center between April 2015 and November 2019 and agreed to an esophagogastroduodenoscopy within 0–14 days (mean: 5 days) following the ablation. To reduce the incidence of thermal lesions three procedural preventive strategies were introduced: (i) videoscopic intrathoracic transesophageal echocardiographic probe visualization to understand the relationship between posterior left atrial wall and esophagus, with probe retraction before ablation; (ii) lifting the cardiac tissue away from the esophagus during energy application; and (iii) a 30-s cool-off period after energy delivery with irrigation of the device, the ablated tissue, and the surrounding tissues. Results No esophageal thermal lesions were observed. One third of patients were diagnosed with incidental esophageal findings unrelated to the ablation procedure (11; 32.4%). Conclusion Novel preventive strategies by visualization and by avoiding contact between the ablation catheter or ablated tissue and the pericardium, seems to eliminate the potential risk of esophageal thermal lesions in the setting of hybrid ablation. Since one third of patients had preexisting esophageal disease, a more comprehensive pre-operative screening could be important to reduce the risk.
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Affiliation(s)
- Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (R.K.); (I.V.L.); (S.G.)
| | - Ines Van Loo
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (R.K.); (I.V.L.); (S.G.)
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (C.d.A.); (G.-B.C.)
| | - Maridi Aerts
- Gastroenterology Department, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium;
| | - Sandro Gelsomino
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (R.K.); (I.V.L.); (S.G.)
| | - Vincent Umbrain
- Anesthesiology Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium;
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (C.d.A.); (G.-B.C.)
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (R.K.); (I.V.L.); (S.G.)
- Correspondence:
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Esophageal Injury and Progression to Atrial-Esophageal Fistula in Catheter Ablation for Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Houmsse M, Daoud EG. Protection of the esophagus during catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:2824-2829. [PMID: 33556991 DOI: 10.1111/jce.14934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/27/2022]
Abstract
Esophageal injury still occurs with high frequency during ablation of atrial fibrillation (AF). The purpose of this study is to provide a review of methods to protect the esophagus from injury during AF ablation. Despite advances in imaging and ablation, the potential risk of esophageal injury during AF ablation remains an important concern with a high occurrence of esophageal injury (≈15%). There have been numerous studies evaluating varied techniques for esophageal protection including active cooling and displacement of the esophagus. These techniques are reviewed in this manuscript as well as the role of esophageal protection in managing patients undergoing AF ablation procedure.
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Affiliation(s)
- Mahmoud Houmsse
- Division of Cardiology, Department of Medicine, Richard M. Ross Heart Hospital, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiology, Department of Medicine, Richard M. Ross Heart Hospital, The Ohio State University Medical Center, Columbus, Ohio, USA
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Houmsse M, Daoud EG, Joseph M, Weiss R, Essandoh M. Evaluation of a novel esophageal retractor utilizing vacuum suction and mechanical force for deviating the esophagus. J Cardiovasc Electrophysiol 2020; 31:1661-1669. [PMID: 32369243 DOI: 10.1111/jce.14529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deviation of the esophagus prevents esophageal injury during atrial fibrillation ablation. OBJECTIVES This study is to evaluate, in animals, safety and effectiveness of a novel esophageal retractor that utilizes vacuum suction and mechanical force to deviate the esophagus. METHODS Following general anesthesia, a radiopaque ruler was placed behind the animal perpendicular to the esophagus. The esophageal retractor was inserted and esophagram was completed. Suction force (280-300 mm Hg) was applied to the distal aspect of the device that resulted in adherence of the esophagus in a circumferential manner. Then movement of a deflecting arm was used to deviate the esophagus. Four animal studies completed: (a) deviation distance and presence of trailing edge; (b) effect of 1 hour continuous suction and deviation upon esophageal cellular architecture; (c) impact on luminal esophageal temperature (LET) during high power ablation; and (d) compatibility of esophageal retractor with electroanatomic mapping system. RESULTS The distance of deviation to the right (26.6 ± 2.5 mm) was higher than to the left (18.7 ± 2.3 mm; P < .01). There was no esophageal trailing edge in 65/68 deviations (96%). With continuous suction for 1 hour, pathology revealed small, <1mm, circular area of hyperemia in the esophageal mucosa. During high power ablation, the maximum increase in LET was 0.2°C. Finally, there was no interference between the device and electro-anatomical mapping system. CONCLUSION In animal models, the esophageal retractor utilizing vacuum suction was successful at deviating the esophagus without significant trailing edge and with minor (1 mm) injury with prolonged continuous suction.
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Affiliation(s)
- Mahmoud Houmsse
- Division of Cardiolovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew Joseph
- Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Essandoh
- Division of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Jiang R, Zei PC, Jiang C. Prevention of left atrium esophagus fistula: Appraisal of existing technologies and strategies. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:646-654. [PMID: 32391576 DOI: 10.1111/pace.13939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 12/17/2022]
Abstract
Catheter ablation has emerged as an effective treatment for atrial fibrillation (AF). Atrial esophageal fistula (AEF) is a rare, but feared complication. With increasing utilization of ablation therapy for AF, the understanding of the relationship between AEF and ablation has been improved in recent years. Efforts to reduce the risk of AEF have focused on decreasing the risk of severe esophageal injury (EI) and the presumed subsequent progression from EI to AEF, including esophageal temperature monitoring, esophageal cooling systems, esophageal deviation devices, and decreasing and/or curtailing ablation energy delivery. Periprocedural assessment may help identify higher risk patients and detect early esophageal lesions. This review systematically summarizes and evaluates the current strategies and techniques utilized to reduce the risk of AEF in the clinical workflow for AF ablation. We expect that this review will help clinicians to better understand the principles, advantages, and disadvantages of these methods, and to find suitable strategies using current available tools.
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Affiliation(s)
- Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, Hangzhou, Zhejiang, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang, China
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, Hangzhou, Zhejiang, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang, China
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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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de Oliveira BD, Oyama H, Hardy CA, de Melo SL, Pisani CF, Chokr MO, Balbo C, da Costa Darrieux FC, Hachul DT, Chaves DM, de Almeida Artifon EL, Cestari IA, Sakai P, Scanavacca MI. Comparative study of strategies to prevent esophageal and periesophageal injury during atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:924-933. [PMID: 32108399 DOI: 10.1111/jce.14417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/10/2020] [Accepted: 01/30/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the prevalence of esophageal and periesophageal thermal injury in patients undergoing radiofrequency (RF) atrial fibrillation (AF) ablation using 8 mm tip catheters during three different esophageal protection strategies. METHODS Forty-five consecutive patients with paroxysmal or persistent AF underwent first ablation procedure, besides esophagogastroduodenoscopy (EGD) combined with radial endosonography (EUS) performed before and after the pulmonary vein (PV) isolation. Before the procedure, patients were randomly assigned to one of three esophageal lesion protection strategies: group I-without any protective or monitoring dispositive and limiting RF applications to 30 W for 20 seconds, in left atrium posterior wall (LAPW); group II-power and time of RF delivery, up to 50 W for 20 seconds at LAPW, limited by esophageal temperature monitoring; group III-applications of RF in LAPW with fixed power application of 50 W for 20 seconds during continuous esophageal cooling. RESULTS Baseline characteristics of patients were similar in all groups. The four PVs were isolated in 14 (93.3%), 13 (86.7%), and 15 (100%) patients, respectively in groups I, II, and III. The mean RF power was significantly higher (P < .001) in the posterior side of PVs in group III. Post-AF ablation EGD and EUS revealed two esophageal wall ulcerations and two periesophageal mediastinal edemas only in the esophageal cooling group (P = .008). CONCLUSION Esophageal cooling balloon strategy resulted in a higher RF power energy delivery when ablating at the LA posterior wall, using 8 mm nonirrigated tip catheters under temperature mode control. Despite that, patients presented a relatively low incidence of esophageal and periesophaeal injuries.
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Affiliation(s)
| | - Helena Oyama
- Bioengineering Service of Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Carina A Hardy
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Sissy L de Melo
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Cristiano F Pisani
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Muhieddine O Chokr
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Conrado Balbo
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Francisco C da Costa Darrieux
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Denise T Hachul
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Dalton M Chaves
- Endoscopy Service of Clinics' Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Idágene A Cestari
- Bioengineering Service of Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Sakai
- Endoscopy Service of Clinics' Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Mauricio I Scanavacca
- Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
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12
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Zhang P, Zhang YY, Ye Q, Jiang RH, Liu Q, Ye Y, Wu JG, Sheng X, Fu GS, Cha YM, Jiang CY. Characteristics of Atrial Fibrillation Patients Suffering Esophageal Injury Caused by Ablation for Atrial Fibrillation. Sci Rep 2020; 10:2751. [PMID: 32066780 PMCID: PMC7026048 DOI: 10.1038/s41598-020-59539-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
The close proximity of esophagus to the left atrial posterior wall predisposes esophagus to thermal injury during catheter ablation for atrial fibrillation (AF). In this retrospective study, we aimed to investigate risk factors of esophageal injury (EI) caused by catheter ablation for AF. Patients who underwent first-time AF ablation from July 2013 to June 2018 were included. The esophagus was visualized by oral soluble contrast during ablation for all patients and a subset of patients were selected to undergo endoscopic ultrasonography (EUS) to estimate EI post ablation. Degree of EI was categorized as Kansas City classification: type 1: erythema; type 2: ulcers (2a: superficial ulcers; 2b: deep ulcers); type 3: perforation (3a: perforation without communication with the atria; 3b: atrioesophageal fistula [AEF]). Of 3,852 patients, 236 patients (61.5 ± 9.7 years; male, 69%) received EUS (EUS group) and 3616 (63.2 ± 10.9 years; male, 61.1%) without EUS (No-EUS group). In EUS group, EI occurred in 63 patients (type 1 EI in 35 and type 2 EI in 28), and no type 3 EI was observed during follow up. In a multivariable logistic regression analysis, an overlap between the ablation lesion and esophagus was an independent predictor of EI (odds ratio, 21.2; 95% CI: 6.23–72.0; P < 0.001). In No-EUS group, esophagopericardial fistula (EPF; n = 3,0.08%) or AEF (n = 2,0.06%) was diagnosed 4–37 days after ablation. In 3 EPF patients, 2 completely recovered with conservative management and 1 died. Two AEF patients died. Ablation at the vicinity of the esophagus predicts risk of EI. EUS post ablation may prevent the progression of EI and should be considered in management of EI. It remains challenging to identify patients with high risk of EI.
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Affiliation(s)
- Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue-Yue Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Ye
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ru-Hong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia-Guo Wu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chen-Yang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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13
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Marashly Q, Chelu MG. Ablation Approaches and Imaging Modalities to Lower Risk of Atrioesophageal Injury During Catheter Ablation for Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-019-0635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Providência R, Adragão P, de Asmundis C, Chun J, Chierchia G, Defaye P, Anselme F, Creta A, Lambiase PD, Schmidt B, Chen S, Cavaco D, Hunter RJ, Carmo J, Combes S, Honarbakhsh S, Combes N, Sousa MJ, Jebberi Z, Albenque J, Boveda S. Impact of Body Mass Index on the Outcomes of Catheter Ablation of Atrial Fibrillation: A European Observational Multicenter Study. J Am Heart Assoc 2019; 8:e012253. [PMID: 31581876 PMCID: PMC6818047 DOI: 10.1161/jaha.119.012253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
Background Outcomes of catheter ablation of atrial fibrillation (AF) are variable and the predictors of success require further elucidation since the identification of correctable risk factors could help to optimize therapy. We aimed to assess the impact of body mass index (BMI) in the overall safety and efficacy of catheter ablation of AF, with emphasis on the use of cryoballoon ablation and novel oral anticoagulants. Methods and Results There were 2497 consecutive patients undergoing catheter ablation of AF in 7 European high volume centers were stratified according to BMI (normal weight <25 kg/m2, pre-obese 25-30 kg/m2, obesity 30-35 kg/m2, and morbid obesity ≥35 kg/m2) and comparisons of procedural outcomes evaluated. Pre-obese and obese patients presented more comorbidities (hypertension, diabetes mellitus, and sleep apnea), and had higher rates of non-paroxysmal AF ablation procedures. The rate of atrial 12-month arrhythmia relapse increased alongside with BMI (35.2%, 35.7%, 43.6%, and 48.0% P<0.001). During a median follow-up of 18.8 months (interquartile range 11-28), after adjusting for all baseline differences, BMI was an independent predictor of relapse (hazard ratio=1.01 per kg/m2; 95% CI 1.01-1.02; P=0.002), adding incremental predictive value to obstructive sleep apnea. BMI was not a predictor for any of the reported complications. Using novel oral anticoagulants and cryoballoon ablation was safe and efficacy was comparable with vitamin-K antagonists and radiofrequency ablation. Conclusions Obese patients present with a more adverse comorbidity profile, more advanced forms of AF, and have lower chances of being free from AF relapse after ablation. Use of novel oral anticoagulants and cryoballoon ablation may be an option in this patient group.
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Affiliation(s)
- Rui Providência
- Clinic Pasteur of ToulouseToulouseFrance
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
- Institute of Health Informatics ResearchUniversity College of LondonUnited Kingdom
| | - Pedro Adragão
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Carlo de Asmundis
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | - Julian Chun
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Gianbattista Chierchia
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | | | | | - Antonio Creta
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Pier D. Lambiase
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Boris Schmidt
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Diogo Cavaco
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Ross J. Hunter
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - João Carmo
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
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15
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Halbfass P, Berkovitz A, Pavlov B, Sonne K, Nentwich K, Ene E, Hoerning F, Barth S, Zacher M, Deneke T. Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index. J Cardiovasc Electrophysiol 2019; 30:2256-2261. [PMID: 31559655 DOI: 10.1111/jce.14193] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Ablation index (AI), a novel parameter defining energy application at single ablation lesions, calculated by integration of ablation time, energy, catheter stability, and contact force, has been documented to be associated with effective lesions and higher ablation efficacy. Using a prespecified target AI in addition to acute lesion efficacy may affect local collateral damage like esophageal thermal injury when used for guiding radiofrequency (RF) ablation at the posterior left atrial (LA) wall. METHODS AND RESULTS Consecutive patients undergoing first AF ablations using AI were included. Ablation energy was reduced to 25 W when ablating at posterior LA wall. Two different individually defined AI target values were used (300 and 350 for posterior wall ablation). Esophageal endoscopy (EE) was performed 1 to 3 days after ablation procedure to document and categorize endoscopically detected esophageal thermal lesion (EDEL). Two-hundred and eleven consecutive patients with postprocedural EE were included. Incidence of EDEL was 14% (29 of 211 patients; mild category 1 lesions in 22 of 29 patients (76%) and severe category 2 lesions (ulcers > 5 mm) in 7 of 29 patients (24% of EDEL group, 3% of total group). Ablation time at posterior LA wall (9.5 vs 9.0 minutes [P = .67]) was comparable in patients with and without EDEL. CONCLUSION LA posterior wall RF ablation adopting AI ≤350 was associated with 14% esophageal thermal injury including 3% of severe esophageal thermal ulcers. This incidence is comparable to historic control groups with non AI-guided AF ablation.
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Affiliation(s)
- Philipp Halbfass
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany.,Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Artur Berkovitz
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Borche Pavlov
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Kai Sonne
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Karin Nentwich
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Elena Ene
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Frank Hoerning
- Department of Internal Medicine, Rhön-Klinikum Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Sebastian Barth
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Michael Zacher
- Department of Clinical Documentation and Statistics, Rhön-Klinikum Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Thomas Deneke
- Clinic for Invasive Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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16
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Wolf M, El Haddad M, De Wilde V, Phlips T, De Pooter J, Almorad A, Strisciuglio T, Vandekerckhove Y, Tavernier R, Crijns HJ, Knecht S, Duytschaever M. Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications. Heart Rhythm 2019; 16:1013-1020. [DOI: 10.1016/j.hrthm.2019.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Indexed: 12/22/2022]
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17
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Kadado AJ, Akar JG, Hummel JP. Luminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review. Trends Cardiovasc Med 2019; 29:264-271. [DOI: 10.1016/j.tcm.2018.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/15/2018] [Accepted: 09/15/2018] [Indexed: 02/07/2023]
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18
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Predicting factors of transmural thermal injury after cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol 2018; 54:101-108. [PMID: 30232688 DOI: 10.1007/s10840-018-0454-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Transmural thermal injury (TTI), such as esophageal erosion/ulcer and periesophageal nerve injury leading to gastric hypomotility, is not rare complications associated with pulmonary vein isolation (PVI). However, the mechanism and predicting factors of TTI have not yet been fully elucidated with second-generation cryoballoon (CB) PVI. METHODS One hundred ten consecutive patients, who underwent CB PVI for atrial fibrillation and received esophagogastroduodenoscopy 2 days later, were investigated. The relationships between TTI and both clinical and anatomical parameters were examined. We measured the following parameters based on the computed tomography data: the angle of the left atrial (LA) posterior wall to the descending aorta (Ao) (LA-Ao angle); the branching angle of the left inferior pulmonary vein (LIPV) to the coronal plane (LIPV angle); and the minimum distance between the LA posterior wall and descending Ao enclosing the esophagus (LA-Ao distance). RESULTS TTIs occurred in 19 patients (esophageal erosion in 2 and gastric hypomotility in 17). The patients with TTI were significantly older than those without TTI. In the anatomical parameters, the LIPV angle was larger and the LA-Ao distance was shorter in the TTI (+) group compared to the TTI (-) group. With the multivariate logistic regression analysis, the age (odds ratio [OR] 2.148, P = 0.022) and LA-Ao distance (OR 0.430, P = 0.013) were independent predictors of TTI. CONCLUSIONS The occurrence of TTI in CB PVI was associated with aging, suggesting compromised periesophageal circulation, and the anatomical proximities between the LA and the descending Ao, which enclose the esophagus.
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19
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Halbfass P, Müller P, Nentwich K, Krug J, Roos M, Hamm K, Barth S, Szöllösi A, Mügge A, Schieffer B, Deneke T. Incidence of asymptomatic oesophageal lesions after atrial fibrillation ablation using an oesophageal temperature probe with insulated thermocouples: a comparative controlled study. Europace 2017; 19:385-391. [PMID: 27540039 DOI: 10.1093/europace/euw070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Oesophageal probes to monitor luminal oesophageal temperature (LET) during atrial fibrillation (AF) catheter ablation have been proposed, but their effects remain unclear. Aim of this study is to evaluate the effects of an oesophageal temperature probe with insulated thermocouples. Methods and results Patients with symptomatic, drug-refractory paroxysmal or persistent AF who underwent left atrial radiofrequency (RF) catheter ablation were prospectively enrolled. Patients were ablated using a single-tip RF contact force ablation catheter. An intraluminal oesophageal temperature probe was used in Group 1. In Group 2, patients were ablated without LET monitoring. Assessment of asymptomatic endoscopically detected oesophageal lesions (EDEL) was performed by oesophagogastroduodenoscopy (EGD) in all patients. Eighty patients (mean age 63.7 ± 10.7 years; men 56%) with symptomatic, drug-refractory paroxysmal (n = 28; 35%) or persistent AF were included. Group 1 and Group 2 patients (n = 40 in each group) were comparable in regard to baseline characteristics, but RF duration on the posterior wall was significantly shorter in Group 1 patients. Overall, seven patients (8.8%) developed EDEL (four ulcerations, three erythema). The incidence of EDEL in Group 1 and Group 2 patients was comparable (7.5 vs. 10%, P = 1.0). No major adverse events were reported in both groups. Conclusion According to these preliminary results, the use of oesophageal temperature probes with insulated thermocouples seems to be feasible in patients undergoing AF RF catheter ablation. The incidence of post-procedural EDEL when using a cut-off of 39°C is comparable to the incidence of EDEL without using a temperature probe.
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Affiliation(s)
- Philipp Halbfass
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Patrick Müller
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany.,University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Karin Nentwich
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Joachim Krug
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Markus Roos
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Karsten Hamm
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Sebastian Barth
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Attila Szöllösi
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany
| | - Andreas Mügge
- University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Schieffer
- Department of Cardiology and Angiology, Philipps University Marburg, Marburg, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany.,University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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20
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Medeiros De Vasconcelos JT, Filho SDSG, Atié J, Maciel W, De Souza OF, Saad EB, Kalil CA, De Castro Mendonça R, Araujo N, Pisani CF, Scanavacca MI. Atrial-oesophageal fistula following percutaneous radiofrequency catheter ablation of atrial fibrillation: the risk still persists. Europace 2017; 19:250-258. [PMID: 28175286 DOI: 10.1093/europace/euw284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/02/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Atrial-oesophageal fistula is a serious complication related to ablation of atrial fibrillation. As its occurrence is rare, there is a great lack of information about their mechanisms, incidence, presentations, and treatment. The objective of this manuscript is to present a series of cases of atrial-oesophageal fistula in Brazil, focusing on incidence, clinical presentation, and follow-up. Methods and results This is a retrospective multicentre registry of atrial-oesophageal fistula cases that occurred in eight Brazilian centres from 2003 to 2015. Ten cases (0.113%) of atrial-oesophageal fistula were reported in 8863 ablation procedures in the period. Most of the subjects were male (70%) with age 59.6 ± 9.3 years. Eight centres were reference units in atrial fibrillation ablation with an experience over than 200 procedures at the time of fistula occurrence. Oesophageal temperature monitoring was performed in eight cases using coated sensors in six. The first atrial-oesophageal fistula clinical manifestation was typically fever (in six patients), with a median onset time of 16.5 (12–43) days after ablation. There was a delay of 7.8 ± 3.3 days between the first manifestation and the diagnosis in five patients. The treatment was surgical in six cases, clinical in three and stenting in one. Seven patients died (70%) and two developed permanent neurological sequelae. Conclusion Atrial-oesophageal fistula remains a serious complication following AF ablation despite the incorporation of protective measures and increased technical experience of the groups. The high morbidity and mortality despite the treatment indicates the need to develop adequate preventive strategies.
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Affiliation(s)
| | | | - Jacob Atié
- Clínica São Vicente and Hospital Universitário da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Washington Maciel
- Clínica São Vicente and Hospital Universitário da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Carlos Antonio Kalil
- Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Cristiano F Pisani
- Instituto do Coração da Universidade de São Paulo, São Paulo, SP, Brazil
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21
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Rillig A, Schmidt B, Di Biase L, Lin T, Scholz L, Heeger CH, Metzner A, Steven D, Wohlmuth P, Willems S, Trivedi C, Galllinghouse JG, Natale A, Ouyang F, Kuck KH, Tilz RR. Manual Versus Robotic Catheter Ablation for the Treatment of Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:875-883. [DOI: 10.1016/j.jacep.2017.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
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22
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Halbfass P, Pavlov B, Müller P, Nentwich K, Sonne K, Barth S, Hamm K, Fochler F, Mügge A, Lüsebrink U, Kuhn R, Deneke T. Progression From Esophageal Thermal Asymptomatic Lesion to Perforation Complicating Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005233. [DOI: 10.1161/circep.117.005233] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Philipp Halbfass
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Borche Pavlov
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Patrick Müller
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Karin Nentwich
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Kai Sonne
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Sebastian Barth
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Karsten Hamm
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Franziska Fochler
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Andreas Mügge
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Ulrich Lüsebrink
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Rainer Kuhn
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
| | - Thomas Deneke
- From the Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt an der Saale, Germany (P.H., B.P., K.N., K.S., S.B., K.H., F.F., T.D.); Department of Cardiology and Angiology, Philipps University Marburg, Germany (P.H., U.L.); Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Germany (P.M.); University Hospital Bergmannsheil, Ruhr-University Bochum, Germany (P.M., A.M., T.D.); and Clinic for Gastroenterology
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Kaneshiro T, Matsumoto Y, Nodera M, Kamioka M, Kamiyama Y, Yoshihisa A, Ohkawara H, Suzuki H, Takeishi Y. Anatomical predisposing factors of transmural thermal injury after pulmonary vein isolation. Europace 2017; 20:1122-1128. [DOI: 10.1093/europace/eux185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Yoshiyuki Matsumoto
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Yoshiyuki Kamiyama
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroshi Ohkawara
- Department of Hematology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
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Leo M, Pedersen MF, Rajappan K, Ginks M, Bashir Y, Betts TR. Premature termination of radiofrequency delivery during pulmonary vein isolation due to oesophageal temperature alerts: impact on acute and chronic pulmonary vein reconnection. Europace 2017; 19:954-960. [PMID: 27247012 DOI: 10.1093/europace/euw102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Oesophageal temperature monitoring is currently used during atrial fibrillation (AF) ablation to prevent atrio-oesophageal fistula. The aim of our study was to investigate if oesophageal temperature alerts, leading to early termination of radiofrequency (RF) energy and/or reduction in power during pulmonary vein isolation, can promote pulmonary vein reconnection (PVR). Methods and results Patients undergone two consecutive AF ablation procedures with a three-dimensional electro-anatomical mapping system and oesophageal temperature monitoring were studied. Any lesions causing oesophageal temperature rises >39°C during the index procedure, leading to premature cessation of RF and/or reduction in power, were labelled on the left atrial geometry in a different colour from standard uninterrupted RF lesions. Acute (at the time of the index procedure) and chronic (at the time of there-do procedure) PVR and the site of subsequent re-isolation were compared with the lesion markers for temperature alerts from the index procedure. Fifty-four patients were included (36 male, mean age 68 ± 8, 59% persistent AF). Forty-six PVs (21% of the total) in 30 patients (56%) had been subject to at least one temperature alert during the index procedure. In 12 patients, 23 PVs had acute PVR requiring further ablation. At the re-do procedure, 103 PVs were found to be reconnected in 44 patients. No correlation was found between the occurrence of temperature alerts at the index procedure and acute or chronic PVR in the associated PV. Conclusion Just over half of patients undergoing PV isolation will have an oesophageal temperature alert, however, precautionary oesophageal temperature monitoring does not compromise ablation efficacy.
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Blockhaus C, Müller P, vom Dahl S, Leonhardt S, Häussinger D, Gerguri S, Clasen L, Schmidt J, Kurt M, Brinkmeyer C, Kelm M, Shin DI, Makimoto H. Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe. Int Heart J 2017; 58:880-884. [DOI: 10.1536/ihj.16-382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christian Blockhaus
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Patrick Müller
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Stephan vom Dahl
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Silke Leonhardt
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Dieter Häussinger
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Lucas Clasen
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Jan Schmidt
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Muhammed Kurt
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Dong-In Shin
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
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Halbfass P, Nentwich K, Krug J, Roos M, Sonne K, Ene E, Hamm K, Barth S, Szöllösi A, Fochler F, Mügge A, Lüsebrink U, Deneke T. Impact of surround flow catheter tip irrigation in contact force ablation on the incidence of asymptomatic oesophageal lesions after atrial fibrillation ablation: a prospective comparative study. Europace 2016; 19:1116-1122. [DOI: 10.1093/europace/euw119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/04/2016] [Indexed: 11/12/2022] Open
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Bhaskaran A, Chik W, Thomas S, Kovoor P, Thiagalingam A. A review of the safety aspects of radio frequency ablation. IJC HEART & VASCULATURE 2015; 8:147-153. [PMID: 28785694 PMCID: PMC5497290 DOI: 10.1016/j.ijcha.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/03/2022]
Abstract
In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT) ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF) and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5-11%, up to 3.4%, up to 1.8% and 4.1-8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.
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Affiliation(s)
- Abhishek Bhaskaran
- Corresponding author at: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
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Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation. Clin Res Cardiol 2015. [PMID: 26199066 DOI: 10.1007/s00392-015-0892-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Long-term results after circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF) using a robotic navigation system (RNS) have not yet been reported. OBJECTIVE To evaluate long-term results of patients with PAF after CPVI using RNS. METHODS In this study, 200 patients (n = 151 (75.5%) male; median age 62.2 (54.7-67.7) years) with PAF were evaluated. In 100 patients, RNS (RN-group) was used for CPVI and compared to 100 manually ablated control patients (MN-group). Radiofrequency was used in conjunction with 3D electroanatomic mapping. Power was limited to 30 watts (W) at the posterior left atrial (LA) wall in the first 49 RNS patients (RN-group-a). After esophageal perforation occurred in one RN-group-a patient, maximum power was reduced to 20 W for the subsequent 51 patients (RN-group-b). RESULTS After a median follow-up of 2 years, single (77/100 vs 77/100, p = 0.89) and multiple (90/100 vs 93/100, p = 0.29) procedure success rates were comparable between RN-group and MN-group. Single procedure success rate was significantly lower in RN-group-a as compared to RN-group-b (65.3 vs 88.2%, p = 0.047). In RN-group-a patients, procedural times [200 (170-230) vs 152 (132-200) minutes, p < 0.01] and fluoroscopy times [16.6 (12.9-21.6) minutes vs 13.7 (9.5-19) minutes, p = 0.043] were significantly longer compared to RN-group-b patients. CONCLUSION Long-term success rate after CPVI using RNS was comparable to manual ablation. Despite a lower power limit of 20 W at the posterior LA wall, single procedure success rate was higher in RN-group-b as compared to RN-group-a. Procedure time and fluoroscopy time decreased, whilst success rate increased with increasing experience in the RN-group.
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29
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Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes. Heart Rhythm 2015; 12:1464-9. [DOI: 10.1016/j.hrthm.2015.04.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Indexed: 11/19/2022]
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Essandoh M, Otey AJ, Crestanello J, Keshishian J, Brady PG, Gerlach RM. CASE 9—2015: Anesthetic Management of a Patient With Esophago-Pericardial Fistula Complicating Atrial Fibrillation Radiofrequency Ablation. J Cardiothorac Vasc Anesth 2015; 29:1357-64. [PMID: 26384634 DOI: 10.1053/j.jvca.2015.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Juan Crestanello
- Surgery, Division of Cardiothoracic Surgery, Ohio State University, Wexner Medical Center, Columbus, OH
| | - Jonathan Keshishian
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Patrick G Brady
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Rebecca M Gerlach
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
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Tschabrunn CM, Silverstein J, Berzin T, Ellis E, Buxton AE, Josephson ME, Anter E. Comparison between single- and multi-sensor oesophageal temperature probes during atrial fibrillation ablation: thermodynamic characteristics. Europace 2015; 17:891-7. [DOI: 10.1093/europace/euu356] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/28/2014] [Indexed: 01/02/2023] Open
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Rillig A, Lin T, Burchard A, Kamioka M, Heeger C, Makimoto H, Metzner A, Wissner E, Wohlmuth P, Ouyang F, Kuck KH, Tilz RR. Modified energy settings are mandatory to minimize oesophageal injury using the novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. Europace 2014; 17:396-402. [DOI: 10.1093/europace/euu269] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nair GM, Nery PB, Redpath CJ, Lam BK, Birnie DH. Atrioesophageal Fistula in the Era of Atrial Fibrillation Ablation: A Review. Can J Cardiol 2014; 30:388-95. [DOI: 10.1016/j.cjca.2013.12.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 12/01/2022] Open
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Kuwahara T, Takahashi A, Takahashi Y, Okubo K, Takagi K, Fujino T, Kusa S, Takigawa M, Watari Y, Yamao K, Nakashima E, Kawaguchi N, Hikita H, Sato A, Aonuma K. Incidences of esophageal injury during esophageal temperature monitoring: a comparative study of a multi-thermocouple temperature probe and a deflectable temperature probe in atrial fibrillation ablation. J Interv Card Electrophysiol 2014; 39:251-7. [DOI: 10.1007/s10840-013-9868-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
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Kuwahara T, Takahashi A, Okubo K, Takagi K, Yamao K, Nakashima E, Kawaguchi N, Takigawa M, Watari Y, Sugiyama T, Handa K, Kimura S, Hikita H, Sato A, Aonuma K. Oesophageal cooling with ice water does not reduce the incidence of oesophageal lesions complicating catheter ablation of atrial fibrillation: randomized controlled study. Europace 2014; 16:834-9. [DOI: 10.1093/europace/eut368] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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TZOU WENDYS, RUSSO ANDREAM. Luminal Esophageal Temperature Monitoring for the Prevention of Esophageal Injury During Left Atrial Ablation: LET It Be? J Cardiovasc Electrophysiol 2013; 24:965-7. [DOI: 10.1111/jce.12198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- WENDY S. TZOU
- Department of Medicine; University of Colorado; Denver Colorado USA
| | - ANDREA M. RUSSO
- Division of Cardiology; Cooper Medical School of Rowan University; Camden New Jersey USA
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CARROLL BRETTJ, CONTRERAS-VALDES FERNANDOM, HEIST EKEVIN, BARRETT CONORD, DANIK STEPHANB, RUSKIN JEREMYN, MANSOUR MOUSSA. Multi-Sensor Esophageal Temperature Probe Used During Radiofrequency Ablation for Atrial Fibrillation is Associated with Increased Intraluminal Temperature Detection and Increased Risk of Esophageal Injury Compared to Single-Sensor Probe. J Cardiovasc Electrophysiol 2013; 24:958-64. [DOI: 10.1111/jce.12180] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/13/2013] [Accepted: 04/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - E. KEVIN HEIST
- MGH Heart Center, Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
| | - CONOR D. BARRETT
- MGH Heart Center, Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
| | - STEPHAN B. DANIK
- MGH Heart Center, Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
| | - JEREMY N. RUSKIN
- MGH Heart Center, Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
| | - MOUSSA MANSOUR
- MGH Heart Center, Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
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Weber H, Sagerer-Gerhardt M. Open-irrigated laser catheter ablation: relationship between the level of energy, myocardial thickness, and collateral damages in a dog model. Europace 2013; 16:142-8. [PMID: 23736805 DOI: 10.1093/europace/eut150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate laser lesion formation in the beating hearts of dogs by using an open-irrigated electrode-laser mapping and ablation heart catheter. METHODS AND RESULTS A total of 50 laser applications at 15 W (n = 31) and 20 W (n = 19) for 10-50 s, with an irrigation flow of 35 mL/min were aimed at the right (n = 15) and left (n = 9) atrial, right (n = 15) and left (n = 11) ventricular walls in five dogs (6-16/dog), by using an open-irrigated laser ablation catheter. The 1064 nm diode laser was provided with a light control system, a Flowmeter, and a transoesophageal laser sensor. Lesions were measured and were evaluated morphometrically. Transmural lesions were achieved in seconds regardless of the level of energy applied. Laser applications at 15 W > 10 s aimed at the atrial walls produced collateral lesions to the lung or to the oesophagus. Laser applications at 20 W > 30 s aimed at the ventricular walls may result in steam pop with intramural cavitations and arrhythmias. Collateral damages to the oesophagus occurred only when the transoesophageal light sensor was deactivated. CONCLUSION To avoid unwanted effects during laser catheter ablation by using an open-irrigated laser catheter energy delivery must be adapted to the thickness of the myocardial wall. Light control system and a transoesophageal light sensor may help reduce the risks of myocardial and collateral damages.
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Affiliation(s)
- Helmut Weber
- CCEP Center, Section Research and Development, Taufkirchen, Schlesierst. 4, D-82024 Taufkirchen, Germany
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Rillig A, Lin T, Ouyang F, Heinz Kuck K, Richard Tilz R. Comparing Antiarrhythmic Drugs and Catheter Ablation for Treatment of Atrial Fibrillation. J Atr Fibrillation 2013; 6:861. [PMID: 28496858 PMCID: PMC5153067 DOI: 10.4022/jafib.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/27/2013] [Accepted: 05/03/2013] [Indexed: 11/10/2022]
Abstract
In the past years, catheter ablation has evolved into an effective treatment option for symptomatic, drug-resistant atrial fibrillation (AF) and it has recently been implemented as a primary treatment strategy for patients with paroxysmal AF. Although a significant number of studies have evaluated the potential benefits of catheter ablation compared with anti-arrhythmic drug (AAD)-therapy, to date, there are only a small number of randomised controlled trials in the literature, and several issues remain unsolved. The aim of this review is to analyze the current literature regarding this important issue and further discuss the question, whether catheter ablation may be more beneficial when compared to AAD therapy.
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Affiliation(s)
- Andreas Rillig
- Asklepios Klinik St. Georg, Hamburg, Germany. Department of Cardiology Electrophysiology
| | - Tina Lin
- Asklepios Klinik St. Georg, Hamburg, Germany. Department of Cardiology Electrophysiology
| | - Feifan Ouyang
- Asklepios Klinik St. Georg, Hamburg, Germany. Department of Cardiology Electrophysiology
| | - Karl Heinz Kuck
- Asklepios Klinik St. Georg, Hamburg, Germany. Department of Cardiology Electrophysiology
| | - Roland Richard Tilz
- Asklepios Klinik St. Georg, Hamburg, Germany. Department of Cardiology Electrophysiology
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RILLIG ANDREAS, SCHMIDT BORIS, STEVEN DANIEL, MEYERFELDT UDO, DI BIASE LUIGI, WISSNER ERIK, BECKER RÜDIGER, THOMAS DIERK, WOHLMUTH PETER, GALLINGHOUSE GJOSEPH, SCHOLZ EBERHARDT, JUNG WERNER, WILLEMS STEFAN, NATALE ANDREA, OUYANG FEIFAN, KUCK KARLHEINZ, TILZ ROLAND. Study Design of the Man and Machine Trial: A Prospective International Controlled Noninferiority Trial Comparing Manual with Robotic Catheter Ablation for Treatment of Atrial Fibrillation. J Cardiovasc Electrophysiol 2012; 24:40-6. [DOI: 10.1111/j.1540-8167.2012.02418.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu E, Shehata M, Liu T, Amorn A, Cingolani E, Kannarkat V, Chugh SS, Wang X. Prevention of esophageal thermal injury during radiofrequency ablation for atrial fibrillation. J Interv Card Electrophysiol 2012; 35:35-44. [PMID: 22717996 DOI: 10.1007/s10840-011-9655-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/16/2011] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW The formation of atrial-esophageal fistula after catheter ablation for atrial fibrillation is a rare but devastating complication with high mortality. Prevention is of utmost importance. We review the usefulness of currently available preventive measures. RECENT FINDINGS Recent studies using endoscopy after atrial fibrillation ablation show the development of esophageal ulcerations in 14-17% of the patients. Risk factors for the occurrence of esophageal ulcerations seem to be a high esophageal luminal temperature during ablation, increased power during energy application at the posterior left-atrial wall, a short left atrium-to-esophagus distance, the use of nasogastric tubes and general anesthesia. The main available tools for prevention of atrial-esophageal fistula include: 1) Assessment of the esophagus position in the preprocedural CT/MRI scan. Its usefulness is limited by the potential of the esophagus to move. 2) Tagging of the esophagus and real-time visualization of its course during the procedure. This can be achieved by introduction of a catheter into the esophagus and visualization in the three-dimensional electroanatomical system, by intracardiac ultrasound or by fluoroscopy. 3) Continuous monitoring of the esophageal luminal temperature during ablation with special temperature sensors. 4) Reduction of power during energy application at the posterior left-atrial wall in close proximity to the esophagus. Despite application of preventive measures, cases of atrial-esophageal fistulas have been reported. SUMMARY Several measures for prevention of atrial-esophageal fistula formation are available nowadays. Although these measures cannot completely eliminate the risk of fistula, it appears prudent to apply a combination of them during atrial fibrillation ablation.
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Thomas D, Scholz EP, Schweizer PA, Katus HA, Becker R. Initial experience with robotic navigation for catheter ablation of paroxysmal and persistent atrial fibrillation. J Electrocardiol 2012; 45:95-101. [DOI: 10.1016/j.jelectrocard.2011.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 10/18/2022]
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Hayman M, Forrest P, Kam P. Anesthesia for Interventional Cardiology. J Cardiothorac Vasc Anesth 2012; 26:134-47. [DOI: 10.1053/j.jvca.2011.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 01/17/2023]
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KORUTH JACOBS, REDDY VIVEKY, MILLER MARCA, PATEL KALPESHK, COFFEY JAMESO, FISCHER AVI, GOMES JANTHONY, DUKKIPATI SRINIVAS, D’AVILA ANDRE, MITTNACHT ALEXANDER. Mechanical Esophageal Displacement During Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2011; 23:147-54. [DOI: 10.1111/j.1540-8167.2011.02162.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leite LR, Santos SN, Maia H, Henz BD, Giuseppin F, Oliverira A, Zanatta AR, Peres AK, Novakoski C, Barreto JR, Vassalo F, d'Avila A, Singh SM. Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures. Circ Arrhythm Electrophysiol 2011; 4:149-56. [DOI: 10.1161/circep.110.960328] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation.
Methods and Results—
Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy.
Conclusions—
A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.
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Affiliation(s)
- Luiz R. Leite
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone N. Santos
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henrique Maia
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benhur D. Henz
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fábio Giuseppin
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anderson Oliverira
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - André R. Zanatta
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayrton K. Peres
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clarissa Novakoski
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jose R. Barreto
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fabrício Vassalo
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andre d'Avila
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheldon M. Singh
- From the Instituto Brasília de Arritmia (L.R.L., S.N.S., H.M., B.D.H., F.G., A.O., A.R.Z., A.K.P., C.N., J.R.B., F.V.), Brasilia, Brasil; Cardiac Arrhythmia Service–Mount Sinai School of Medicine (A.d'A.), New York, NY; and Schulich Heart Program (S.M.S.), Division of Cardiology, Sunnybrook Health Sciences Center, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Shalaby A, Refaat M, Sebastien G, Zenati M. Conservative management of pericardial-esophageal fistula complicating robotic atrial fibrillation ablation. Heart Rhythm 2011; 8:905-8. [PMID: 21278000 DOI: 10.1016/j.hrthm.2011.01.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 01/20/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Alaa Shalaby
- Division of Cardiology, University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
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Hernández-Madrid A, Matía Francés R, Moro C. Novedades en electrofisiología cardiaca y arritmias. Rev Esp Cardiol 2011; 64 Suppl 1:81-90. [DOI: 10.1016/s0300-8932(11)70011-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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DENEKE THOMAS, BÜNZ KATHRIN, BASTIAN ANNELY, PÄSLER MARCUS, ANDERS HELGE, LEHMANN RAINER, MEUSER WOLFGANG, DE GROOT JORISR, HORLITZ MARC, HABERKORN RON, MÜGGE ANDREAS, SHIN DONGIN. Utility of Esophageal Temperature Monitoring During Pulmonary Vein Isolation for Atrial Fibrillation Using Duty-Cycled Phased Radiofrequency Ablation. J Cardiovasc Electrophysiol 2010; 22:255-61. [DOI: 10.1111/j.1540-8167.2010.01916.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sommer P, Hindricks G. Prevention of oesophageal injury during catheter ablation of atrial fibrillation: is monitoring of oesophageal temperature the solution? Europace 2010; 12:911-2. [DOI: 10.1093/europace/euq138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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