Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis.
Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis.
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DOI：
10.1007/s10840-019-00661-5
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Kulstad E
中科院分区：
文献类型：
--
作者：
Leung LW;Gallagher MM;Santangeli P;Tschabrunn C;Guerra JM;Campos B;Hayat J;Atem F;Mickelsen S;Kulstad E
射频消融左心房治疗房颤对食道的热损伤是一种风险。最极端的热损伤类型会导致房-食管瘘(AEF)和相应的高死亡率。已经开发了各种减少食道损伤的策略，包括动力减少、食道偏曲和食道降温。一种冷却食道的方法是在射频消融过程中直接向食道内注入冷水或生理盐水。尽管这种方法提供的取热能力有限，但对它的研究表明了潜在的好处。我们试图对已发表的研究进行荟萃分析，评估射频消融术中通过直接液体注入降低热损伤的食道冷却的使用情况。我们在PubMed上搜索在射频消融过程中使用食道冷却来保护食道免受热损伤的研究。然后，我们使用随机效应模型进行荟萃分析，以95%的可信区间计算估计的效应大小，根据术后内窥镜检查的严重程度对食道病变的结果进行分层。共确定并回顾了9项研究。排除临床前和数学模型研究后，3个纳入荟萃分析，共计494名患者。食道冷却有向下转移病变严重程度的趋势，使得病变总数无统计学意义的变化(OR 0.6，95%CI 0.15至2.38)。对于高级别病变，支持食道冷却的OR为0.39(95%可信区间0.17~0.89)，表明即使采用低容量热抽吸技术，食道冷却也能降低射频消融所致病变的严重程度。食道冷却可以降低射频消融可能导致的病变的严重程度，即使在使用相对较低的热提取方法时也是如此，例如直接滴入少量冷液。有必要对这种方法进行进一步的研究，特别是在具有更高的热吸收能力的技术上。
Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation. Esophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
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DOI：
10.1111/j.1540-8167.2006.00693.x
发表时间：
2007-02-01
影响因子：
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作者：
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DOI：
10.1111/j.1540-8167.2008.01229.x
发表时间：
2008-11-01
影响因子：
2.7
作者：
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