Esophageal Deviation During Atrial Fibrillation Ablation Clinical Experience With a Dedicated Esophageal Balloon Retractor
Esophageal Deviation During Atrial Fibrillation Ablation Clinical Experience With a Dedicated Esophageal Balloon Retractor
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DOI：
10.1016/j.jacep.2018.04.001
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发表时间：
2018-08-01
影响因子：
7
通讯作者：
Reddy, Vivek Y.
中科院分区：
文献类型：
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作者：
Bhardwaj, Rahul;Naniwadekar, Aditi;Reddy, Vivek Y.
目的 本研究的目的是确定新型食管球囊牵开器 (DV8) 在 PVI 期间用于 MED 的安全性和可行性。 背景 作者之前表明，使用现成的金属管心针进行机械食管偏斜 (MED) 是可行的，以便在肺静脉隔离 (PVI) 期间沿左心房后部不间断消融。虽然这是一种避免食管热损伤的有吸引力的策略，但该技术受到僵硬管心针造成口咽部损伤的倾向和有限的侧向食管移位的阻碍。方法在200名连续接受房颤消融的患者中，使用DV8球囊牵开器进行MED；将造影剂注入食管以准确描绘食管后缘。进行偏差以最大化从食管后缘到消融线最近点的距离 (MEDEffective)，并与管腔食管温度升高的发生相关。结果 在 304 对静脉对的首次 PVI 期间接受 MED 的患者中，右侧和左侧 PVI 期间的 MEDeffective 分别为 21.2 +/- 8.7 mm 和 15.5 +/- 6.8 mm。 97.7% 的 MEDeffective 偏差至少为 5 毫米。 MEDEffective 20 mm 处食管腔温度普遍升高 (100%)。没有出现食管并发症，但 2 名患者因装置放置相关的创伤而出现口咽出血。 结论 在房颤消融期间，使用球囊牵开器的 MED 安全地将食管移离能量输送部位。 (C) 2018 年，美国心脏病学会基金会。
OBJECTIVES The goal of this study was to determine the safety and feasibility of a novel esophageal balloon retractor (DV8) for MED during PVI.BACKGROUND The authors previously showed that mechanical esophageal deviation (MED) is feasible using an offthe-shelf metal stylet to allow uninterrupted ablation along the posterior left atrium during pulmonary vein isolation (PVI). Although it is an attractive strategy to avoid esophageal thermal injury, this technique was hampered by both the propensity for oropharyngeal trauma from the stiff stylet and the limited lateral esophageal displacement.METHODS In 200 consecutive patients undergoing atrial fibrillation ablation, the DV8 balloon retractor was used for MED; contrast was instilled into the esophagus to accurately delineate the trailing esophageal edge. Deviation was performed to maximize the distance from the trailing esophageal edge to the closest point of the ablation line (MEDEffective) and correlated to occurrences of luminal esophageal temperature elevation.RESULTS In patients undergoing MED during a first-ever PVI of 304 vein pairs, the MEDEffective during right and left PVI were 21.2 +/- 8.7 mm and 15.5 +/- 6.8 mm, respectively. Deviation of at least 5 mm of MEDEffective was achievable in 97.7%. Luminal esophageal temperature increases universally occurred (100%) at MEDEffective 20 mm. There were no esophageal complications, but 2 patients experienced oropharyngeal bleeding due to trauma related to device placement.CONCLUSIONS MED with the balloon retractor safely moved the esophagus away from the site of energy delivery during atrial fibrillation ablation. (C) 2018 by theAmerican College of Cardiology Foundation.