Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium
Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium
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DOI：
10.1161/circulationaha.104.509612
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发表时间：
2005-07-26
期刊：
影响因子：
37.8
通讯作者：
Natale, A
中科院分区：
文献类型：
--
作者：
Cummings, JE;Schweikert, RA;Natale, A
左心房食管瘘是房颤消融术的一种严重并发症.没有标准的方法来避免这种并发症，这是由消融过程中的热损伤引起的。本研究的目的是评估过程中的食管和食管内的温度在肺静脉窦隔离（PVAI）和相关的这些数据与食管组织damage.Methods和结果-八一患者提出的PVAI进行食管评估，包括温度探头的位置。通过计算机断层扫描、3D成像（NAVX）或心内超声心动图获得食管进程。对于每个病变，记录功率、导管和食管温度、位置和微泡的存在。病变部位和食管行程由6个预定的左心房解剖段确定。内镜检查评价了PVAI期间和之后的组织变化。81例患者中，食管位于右肺静脉附近23例（28.4%），左肺静脉附近31例（38.3%），中后壁附近27例（33%）。食管温度在左心房病变沿着其过程中明显高于病变其他部位（38.9 +/- 1.4 ℃，36.8 +/- 0.5 ℃，P < 0.01）。产生微泡的病变的食管温度高于未产生微泡的病变（39.3 +/- 1.5 ℃，38.5 +/- 0.9 ℃，P < 0.01）。功率不能预测食管温度。食管和左心房之间的距离为4.4 +/- 1.2 mm。结论-与不产生微泡的病变相比，食管附近产生微泡的病变显著增加了食管温度。功率与食管温度无关。食管的变异性使得沿着其病程难以避免病变。重点不是避免后部病变，而是更好地监测食管，以创建更安全的病变。
Background - Left atrioesophageal fistula is a devastating complication of atrial fibrillation ablation. There is no standard approach for avoiding this complication, which is caused by thermal injury during ablation. The objectives of this study were to evaluate the course of the esophagus and the temperature within the esophagus during pulmonary vein antrum isolation (PVAI) and correlate these data with esophagus tissue damage.Methods and Results - Eight-one patients presenting for PVAI underwent esophagus evaluation that included temperature probe placement. Esophagus course was obtained with computed tomography, 3D imaging (NAVX), or intracardiac echocardiography. For each lesion, the power, catheter and esophagus temperature, location, and presence of microbubbles were recorded. Lesion location and esophagus course were defined with 6 predetermined left atrial anatomic segments. Endoscopy evaluated tissue changes during and after PVAI. Of 81 patients, the esophagus coursed near the right pulmonary veins in 23 (28.4%), left pulmonary veins in 31 (38.3%), and mid-posterior wall in 27 (33%). Esophagus temperature was significantly higher during left atrial lesions along its course than with lesions elsewhere (38.9 +/- 1.4 degrees C, 36.8 +/- 0.5 degrees C, P < 0.01). Lesions that generated microbubbles had higher esophagus temperatures than those without (39.3 +/- 1.5 degrees C, 38.5 +/- 0.9 degrees C, P < 0.01). Power was not predictive of esophagus temperatures. Distance between the esophagus and left atrium was 4.4 +/- 1.2 mm.Conclusions - Lesions near the course of the esophagus that generated microbubbles significantly increased esophagus temperature compared with lesions that did not. Power did not correlate with esophagus temperatures. Esophagus variability makes the avoidance of lesions along its course difficult. Rather than avoiding posterior lesions, emphasis could be placed on better esophagus monitoring for creation of safer lesions.