Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation.
Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation.
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DOI：
10.1007/s10840-023-01474-3
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发表时间：
2023-10
影响因子：
1.8
通讯作者：
Metzl, Mark
中科院分区：
文献类型：
--
作者：
Joseph, Christopher;Nazari, Jose;Zagrodzky, Jason;Brumback, Babette;Sherman, Jacob;Zagrodzky, William;Bailey, Shane;Kulstad, Erik;Metzl, Mark
关键词：
在肺静脉隔离(PVI)联合射频消融(RF)治疗房颤(AF)时，主动食道降温正越来越多地被用于减少食道损伤和房食管瘘的形成。随机对照数据还显示，在使用主动冷却时，从房颤中获得更多自由度的趋势。本研究旨在比较在左房消融术中接受管腔食道温度(LET)监测和主动食道降温治疗的患者的1年心律失常复发率。两个医疗系统(包括3家医院和4名电生理学家)的数据在接受PVI治疗房颤后1年的随访中被回顾患者的心律状态。使用Kaplan-Meier估计对接受主动食道冷却治疗的患者(EnsoETM，Attune Medical，伊利诺伊州芝加哥)和接受传统LET监测的患者的结果进行了比较。共回顾了513名患者；253名患者接受了使用单传感器或多传感器温度探头的LET监测；260名患者接受了主动降温。平均年龄66.8岁(SD ± 10岁)，女性占36.8%。心律失常中阵发性房颤占60.1%，持续性房颤占34.3%，长期持续性房颤占5.6%，组间比较差异无统计学意义。在1年的随访中，KM估计摆脱房颤的LET监测患者为58.2%，主动降温患者为72.2%，主动食道降温患者完全摆脱房颤的比例增加了14%(p = .03)。调整患者年龄、性别、房颤类型和操作者与治疗概率相反的混杂因素，加权COX比例风险模型得出降温对房颤复发的影响的风险比为0.6%(p = 0.045)。在这项关于食道保护策略与左房射频消融远期疗效之间关系的首个研究中，与接受LET监测的患者相比，主动食道降温治疗的患者一年内房性心律失常的发生率在临床和统计学上有显著改善。需要更严格的前瞻性研究或随机研究来验证当前研究的结果。
Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation. Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) and those treated with traditional LET monitoring using Kaplan–Meier estimates. A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes; and 260 received active cooling. The mean age was 66.8 (SD ± 10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045). In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
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影响因子：
24
作者：
Okada, Taro;Yamada, Takumi;Murohara, Toyoaki
通讯作者：
Murohara, Toyoaki
DOI：
10.1198/016214501753168154
发表时间：
2001-06-01
影响因子：
3.7
作者：
Hernán, MA;Brumback, B;Robins, JM
通讯作者：
Robins, JM
影响因子：
3.5
作者：
Berjano, EJ;Hornero, F
通讯作者：
Hornero, F
DOI：
10.1007/s10840-019-00661-5
发表时间：
2020-11
期刊：
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
影响因子：
--
作者：
Leung LW;Gallagher MM;Santangeli P;Tschabrunn C;Guerra JM;Campos B;Hayat J;Atem F;Mickelsen S;Kulstad E
通讯作者：
Kulstad E
影响因子：
3.6
作者：
Li Z;Wang S;Hidru TH;Sun Y;Gao L;Yang X;Xia Y
通讯作者：
Xia Y