Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation.
Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation.
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DOI：
10.1080/02656736.2022.2121860
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发表时间：
2022
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--
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使用新型冷却器械的主动冷却已被证明可减少使用中等功率设置治疗房颤的射频（RF）消融术期间经内窥镜识别的热损伤。我们旨在评价高功率短时（HPSD）消融期间主动冷却的效果。创建了一个考虑左心房（1.5 mm厚）和食道（包括主动冷却装置）的计算机模型。我们使用Arkyius方程来估计在50 W-10 s和90 W-4 s射频消融期间的食管热损伤。在主动食管冷却到位的情况下，食管组织中的温度从没有冷却的对照条件显著降低，并且对食管壁的损伤的所得百分比降低约50%，从而限制了对食管上区域的损伤，并且因此保留了食管组织的其余部分，包括粘膜表面。尽管冷却，心房壁中的病变仍保持透壁，最大宽度几乎没有变化（<0.8 mm）。在HPSD消融期间，主动食管冷却显著降低了食管温度和由此产生的损伤分数。这些发现提供了一个机械原理，解释了迄今为止使用主动食管冷却遇到的高度安全性，并进一步强调了温度监测不足以避免食管热损伤的事实。
Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation. A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W–10 s and 90 W–4 s RF ablations. With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm). Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus.
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影响因子：
3.1
作者：
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