Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm Cryoballoon
Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm Cryoballoon
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DOI：
10.1161/circep.113.000228
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发表时间：
2013-08-01
影响因子：
8.4
通讯作者：
Wissner, Erik
中科院分区：
文献类型：
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作者：
Metzner, Andreas;Burchard, Andre;Wissner, Erik
背景-肺静脉电隔离是房颤的一种既定治疗选择。到目前为止，消融引起的食管热损伤（ETL）的发病率和质量使用最近推出的第二代冷冻球囊（CB，ArcticFront Advance，Medtronic）是未知的。方法和结果在药物难治性阵发性房颤或短期持续性房颤患者，肺静脉（PV）隔离进行使用第二代CB。通过温度探头监测腔内食管温度。肺静脉隔离后，进行食管胃镜检查（EGD）以评估ETL的发生率。在50例患者（18例女性;年龄：61 ± 11岁;左心房直径：43 ± 5 mm）中，成功进行了基于CB的肺静脉隔离。右上级肺静脉的最低中位球囊温度和食管温度分别为-51 ℃和35.8 ℃，右下肺静脉为-47 ℃和35 ℃，左上级肺静脉为-51 ℃和34.4 ℃，左下肺静脉为-48 ℃和34.6 ℃，左公共PV分别为-54 ℃和34.5 ℃。消融后2 +/- 1天进行的EGD显示，50例患者中分别有>= 1例（2%）和5例（10%）出现浅表热损伤和热溃疡。在ETL患者中，在1个冷冻循环期间，测量的腔内食管温度
Background-Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.Methods and Results-In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61 +/- 11 years; left atrial diameter, 43 +/- 5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51 degrees C and 35.8 degrees C, -47 degrees C and 35 degrees C for the right inferior PV, -51 degrees C and 34.4 degrees C for the left superior PV, -48 degrees C and 34.6 degrees C for the left inferior PV, and -54 degrees C and 34.5 degrees C for the left common PV, respectively. EGD performed 2 +/- 1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in >= 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during 1 freeze cycle the endoluminal esophageal temperature measured