An Insight to the Role of Thermal Effects on the Onset of Atrioesophageal Fistula: A Computer Model of Open-Irrigated Radiofrequency Ablation
An Insight to the Role of Thermal Effects on the Onset of Atrioesophageal Fistula: A Computer Model of Open-Irrigated Radiofrequency Ablation
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DOI：
10.1007/s13239-020-00465-z
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发表时间：
2020-05-14
影响因子：
1.8
通讯作者：
Savory, Eric
中科院分区：
文献类型：
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作者：
Avari, Hamed;Berkmortel, Carolyn;Savory, Eric
目的心房颤动（atrial fibrillation，AF）是世界上最常见的心律失常.射频消融术（RFCA）已成为治疗药物难治性房颤的首选方法，心房食管瘘（AEF）是RFCA罕见（< 0.2%）但致命（约80%）的并发症之一。虽然发展AEF的确切病理生理学事件尚未完全了解，但有一种假设认为根本原因可能是粘膜（食管腔）的热损伤。方法建立食管旁左心房后壁射频消融的计算机模型。通过考虑一系列解剖学变化（从临床数据中获得），采用了一种新的系统方法，以研究当施加射频能量以在粘膜中产生50 ℃阈值温度时的空间和时间温度数据。该模型还用于研究粘膜温度的空间和时间变化，如果没有准确定位，可能会影响食管温度监测装置读数的可靠性。结果：如果50 ℃的温度阈值是识别热损伤的唯一标准，则结果表明除一个解剖结构外，所有解剖结构均存在透壁食管病变的证据。然而，通过考虑时间的影响（温度-时间积分），只有一些解剖结构被确定为部分受损。研究消融过程中的温度和温度梯度数据发现，温度和温度梯度的增加取决于时间、位置和解剖结构。这一发现可能对下一代温度监测设备的设计和开发具有重要意义，这些设备将提供温度图而不是单点测量。结论本研究为探讨射频治疗过程中多种因素的影响以及它们与AEF发生的关系提供了更方便的平台。
Purpose Atrial fibrillation (AF) is the most common heart rhythm disorder in the world. Radiofrequency catheter ablation (RFCA) has become the preferred method of treatment for drug-refractory AF. One of the rare (< 0.2%) but deadly (approximate to 80%) complications of RFCA is Atrioesophageal fistula (AEF). Although the exact pathophysiological events in developing AEF are not fully understood, one hypothesis is that the underlying cause may be thermal damage to the mucosa (the esophagus lumen). Method The present study reports on a computer model of RFCA in the posterior wall of the left atrium (LA) which is in close proximity to the esophagus. A novel systematic approach was taken by considering a range of anatomical variations (obtained from clinical data) to study the spatial and temporal temperature data when RF energy was applied to cause a threshold temperature of 50 degrees C in the mucosa. The model is also used to investigate the spatial and temporal changes in mucosal temperature that may affect the reliability of the readings from esophageal temperature monitoring devices if they are not positioned accurately. Results The results suggest evidence of transmural esophageal lesions in all the anatomies except one, if the 50 degrees C temperature threshold is the only criteria used for identification of thermal damage. However, by taking into consideration the effect of time (temperature-time integral), only some anatomies were identified as being partially damaged. Investigating the temperature and the temperature gradient data during the ablation revealed that the increases in both the temperature and the temperature gradient were time, location and anatomy dependent. This finding may have significance in the design and development of next-generation temperature monitoring devices that will provide a temperature map rather than single point measurements. Conclusion Studies such as the present work may provide more convenient platforms for investigating the effect of the many factors involved in the RF procedure and how they may link to the development of AEF.