Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study
| Autor: | Henrique Maia, Ayrton Klier Péres, Anderson Oliverira, Andre d'Avila, Sheldon M. Singh, Fabio F. Giuseppin, Fabrício Vassalo, Benhur D. Henz, Clarissa Novakoski, Jose R. Barreto, André Rodrigues Zanatta, Luiz Roberto Leite, Simone N. Santos |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Catheters Radiofrequency ablation medicine.medical_treatment Catheter ablation Pilot Projects Esophageal ulceration law.invention Body Temperature Esophageal Fistula Esophagus law Predictive Value of Tests Physiology (medical) Monitoring Intraoperative Atrial Fibrillation medicine Humans Prospective Studies Ulcer Ultrasonography Interventional Aged Ontario Chi-Square Distribution medicine.diagnostic_test business.industry Atrial fibrillation Equipment Design Middle Aged Ablation medicine.disease Endoscopy Surgery Catheter medicine.anatomical_structure Catheter Ablation Female Radiology Esophagoscopy Cardiology and Cardiovascular Medicine business Burns |
| Zdroj: | Circulation. Arrhythmia and electrophysiology. 4(2) |
| ISSN: | 1941-3084 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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