Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: A pilot study
Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: A pilot study
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DOI：
10.1111/j.1540-8167.2006.00693.x
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发表时间：
2007-02-01
影响因子：
2.7
通讯作者：
Kugimiya, Hiroshi
中科院分区：
文献类型：
--
作者：
Tsuchiya, Takeshi;Ashikaga, Keiichi;Kugimiya, Hiroshi
心房颤动消融术中的食管冷却。简介：左心房食管瘘是一种罕见但破坏性的并发症，可能发生在房颤（AF）消融术期间，可能是由于射频（RF）消融术期间发生的热损伤。我们研究的可行性食管冷却（ECO）的方法，使用冷却水冲洗食管内球囊（IB）。方法和结果：8例药物难治性房颤患者接受射频导管消融术，环绕同侧肺静脉。在左心房后射频消融期间，使用球囊长度为40 mm、直径为10 mm的9 Fr IB导管冷却食管腔，其中冷却水的水温为4.5 +/- 3.1 ℃，灌注，同时测量食管腔温度（LET）使用放置在靠近消融导管尖端部位的食管内探头进行测量。在对照组中，在3.9 +/- 1.2射频能量应用期间，LET在26.1 +/- 8.2秒内从36.4 +/- 0.8 ℃增加到40.5 +/- 1.7 ℃，而ECO在基线时LET降低到30.2 +/- 2.9 ℃（P < 0.01 vs对照），并且在3.9 +/- 1.2 RF能量应用期间，在30秒内最多仅升高至33.5 +/- 2.9 ℃（P < 0.01 vs对照）。所有患者均成功分离肺静脉，无任何并发症。在3.1 +/- 1.2个月的随访期间，没有观察到食道损伤，除一名患者外，所有患者均没有任何症状。结论：使用IB成功降低了LET。这可能具有预防食管损伤的潜力，但需要进一步研究。
Esophageal Cooling During Atrial Fibrillation Ablation. Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water-irrigated intraesophageal balloon (IB).Methods and Results: Eight patients with drug-refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9-Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 +/- 3.1 degrees C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 +/- 0.8 degrees C to 40.5 +/- 1.7 degrees C within 26.1 +/- 8.2 seconds during 3.9 +/- 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 +/- 2.9 degrees C at baseline (P < 0.01 vs control), and increased only to 33.5 +/- 2.9 degrees C (P < 0.01 vs control) at most, within 30 seconds during 3.9 +/- 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow-up period of 3.1 +/- 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.