Effectiveness of esophagus detection by three-dimensional electroanatomical mapping to avoid esophageal injury during ablation of atrial fibrillation.
Effectiveness of esophagus detection by three-dimensional electroanatomical mapping to avoid esophageal injury during ablation of atrial fibrillation.
复制标题
通过三维电解剖测绘检测食管的有效性，以避免房颤消融过程中食管损伤。
DOI：
10.1016/j.jjcc.2012.02.009
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发表时间：
2012
期刊：
影响因子：
2.5
通讯作者：
Maenosono R
中科院分区：
文献类型：
--
作者：
Horie S;Yamasaki T;Okamoto T;Kan S;Ogata K;Miyauchi S;Tobimatsu S.;Maenosono R
房颤（AF）消融术期间的心房-左心房（LA）瘘是一种致命事件。我们探讨了食管到消融点的距离和食管温升的关系。METHODS对比患者（n=106）进行了复杂的碎裂心房电图引导的AF消融使用CartoMerge;肺静脉隔离23例。食管附近的最大射频（RF）功率为15 W。标记食管温度升高（用探头监测）至≥38.0°C的消融点;如果≥39.0°C，则停止RF。在食管附近的1647个消融点中，274个与温度升高至38.0-38.9°C相关，241个与温度升高至≥39.0°C相关。点到食管的距离（mm）为5.1±0.6（无升高）、4.2±3.1（38.0-38.9°C）、2.9±2.5（≥39.0°C）。总的来说，左心房后壁上部15.5%的点、中部41.5%的点和下部30.2%的点导致升高至≥38.0°C; 8.7%、24.6%和11.0%的点导致升高至≥39.0°C。如多元逻辑回归分析所示，中壁受影响最大（p<0.01）（两种温度）。随着距离的减小，引起升高的点显著增加（p<0.001）。与5.0 mm距离相比，升高至≥38.0°C的比值比<4.0 to >为2.28（p=0.004）。≥38.0°C升高的最大距离为18.5mm。结论距离是食管温度升高的重要预测因素。左心房后壁中部最脆弱。15 W的剂量对于消融来说太高，特别是<4.0mm from the esophagus. Points >20.0mm的距离相对安全。
AIMSEsophageal-left atrial (LA) fistula during atrial fibrillation (AF) ablation is a fatal event. We explored the relation of the esophagus-to-ablated point distance and esophageal temperature rise.METHODSConsecutive patients (n=106) underwent complex fractionated atrial electrogram-guided AF ablation using CartoMerge; the pulmonary veins were isolated in 23 patients. Maximum radiofrequency (RF) power near the esophagus was 15W. Ablated points with esophageal temperature rise (monitored with a probe) to ≥38.0°C were tagged; if ≥39.0°C, RF was discontinued.RESULTSOf 1647 ablated points near the esophagus, 274 were associated with a temperature rise to 38.0–38.9°C and 241 points to ≥39.0°C. Distances (mm) from points to esophagus were 5.1±0.6 (no rise), 4.2±3.1 (38.0–38.9°C), 2.9±2.5 (≥39.0°C). Altogether, 15.5% of points in the upper LA posterior wall, 41.5% in the middle, and 30.2% in the lower caused rises to ≥38.0°C; 8.7%, 24.6%, and 11.0% caused rises to ≥39.0°C. The middle wall was most affected (p<0.01), as shown by multiple logistic regression analysis (both temperatures). Points causing a rise increased significantly as distance decreased (p<0.001). The odds ratio for rise to ≥38.0°C compared with <4.0 to >5.0mm distance was 2.28 (p=0.004). The longest distance for ≥38.0°C rise was 18.5mm.CONCLUSIONDistance is an important predictor of esophageal temperature rise. The middle LA posterior wall is most vulnerable. A dose of 15W is too high for ablation, especially <4.0mm from the esophagus. Points >20.0mm away are relatively safe.