Catheter ablation of atrial fibrillation using ablation index-guided high power (50 W) for pulmonary vein isolation with or without esophageal temperature probe (the AI-HP ES0 II)
Catheter ablation of atrial fibrillation using ablation index-guided high power (50 W) for pulmonary vein isolation with or without esophageal temperature probe (the AI-HP ES0 II)
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DOI：
10.1016/j.hrthm.2020.05.029
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发表时间：
2020-11-01
期刊：
影响因子：
5.5
通讯作者：
Chun, K. R. Julian
中科院分区：
文献类型：
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作者：
Chen, Shaojie;Schmidt, Boris;Chun, K. R. Julian
大功率短时间消融肺静脉电隔离术（PVI）治疗心房颤动（AF）可简化手术并提高疗效;但是，在此情况下，食管损伤仍然是一个安全问题。目的本研究的目的是探讨食管腔温度（LET）监测在高血压期间的作用。方法对有症状的房颤患者进行消融指数引导的高功率（AI-HP）PVI（50 W; AI前壁/后壁：550/400）。在第一组连续患者中，使用绝缘食管温度探头进行LET监测（截止LET >39 ℃）（A组）。在第二组连续患者中，未使用探头（B组）。所有患者在消融后1-3天接受食管内镜检查。结果共有120例患者（A组60例; B组60例）被纳入本研究（平均年龄67.8岁; 64%为男性）。两组的基线特征和手术结局相似。所有患者均实现了手术肺静脉隔离。肺静脉隔离一次通过率为96.6%。平均手术射频（RF）时间为11.5分钟，平均手术时间为55.5分钟，X线透视时间为5.6分钟。左心房后壁的平均贴靠力为23 g，左心房后壁的平均射频消融时间为3.2分钟。A组2例患者和B组1例患者出现内镜下小食管病变（P = 0.99）。结论在接受AI-HP（50 W）PVI的患者中，使用和不使用温度探头进行LET监测（截止温度39 ℃）的患者中，消融相关内镜食管病变的发生率均较低。
BACKGROUND High-power, short-duration ablation for pulmonary vein isolation (PVI) in the treatment of atrial fibrillation (AF) facilitates the procedure and improve effectiveness; however, esophageal injury remains a safety concern.OBJECTIVE The purpose of this study was to investigate the role of luminal esophageal temperature (LET) monitoring during high-power ablation for PVI in terms of endoscopic esophageal lesion.METHODS Patients with symptomatic AF underwent ablation index-guided high-power (AI-HP) PVI (50 W; AI anterior wall/posterior wall: 550/400). In the first consecutive set of patients, an insulated esophageal temperature probe was used for LET monitoring (cutoff LET >39 degrees C) (group A). In the second consecutive set of patients, the probe was not used (group B). All patients were scheduled to undergo esophageal endoscopy 1-3 days after ablation.RESULTS A total of 120 patients (60 group A; 60 group B) were included in the study (mean age 67.8 years; 64% male). Baseline characteristics and procedural outcomes were similar between the 2 groups. Procedural PVI was achieved in all patients. First-pass PVI rate was 96.6%. Mean procedural radiofrequency (RF) time was 11.5 minutes, mean procedural time was 55.5 minutes, and fluoroscopic time was 5.6 minutes. Mean contact force at the LA posterior wall was 23 g, and mean RF ablation time at the LA posterior wall was 3.2 minutes. Two patients in group A and 1 patient in group B had endoscopic small esophageal lesions (P = .99). No serious procedural adverse events were observed.CONCLUSION Among patients undergoing AI-HP (50 W) PVI, the incidences of ablation-related endoscopic esophageal lesion in patients with and those without use of a temperature probe for LET monitoring (cutoff 39 degrees C) were comparably low.