Effectiveness of esophagus detection by three-dimensional electroanatomical mapping to avoid esophageal injury during ablation of atrial fibrillation

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• 作者：Ryuichi Maenosono ; Naoya Oketani ; Sanemasa Ishida ; Yasuhisa Iriki ; Hitoshi Ichiki ; Hideki Okui ; Yuichi Ninomiya ; Shuichi Hamasaki ; Fuminori Namino ; Masakaze Matsushita ; Chuwa Tei ; Teruto Hashiguchi
• 关键词：Atrial fibrillation ; Ablation ; Complex fractionated atrial electrogram ; Esophageal temperature
• 刊名：Journal of Cardiology
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：60
• 期：2
• 页码：119-125
• 全文大小：831 K

文摘

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Summary

Aims

Esophageal-left atrial (LA) fistula during atrial fibrillation (AF) ablation is a fatal event. We explored the relation of the esophagus-to-ablated point distance and esophageal temperature rise.

Methods

Consecutive patients (n = 106) underwent complex fractionated atrial electrogram-guided AF ablation using CartoMerge; the pulmonary veins were isolated in 23 patients. Maximum radiofrequency (RF) power near the esophagus was 15 W. Ablated points with esophageal temperature rise (monitored with a probe) to ¡Ý38.0 ¡ãC were tagged; if ¡Ý39.0 ¡ãC, RF was discontinued.

Results

Of 1647 ablated points near the esophagus, 274 were associated with a temperature rise to 38.0-38.9 ¡ãC and 241 points to ¡Ý39.0 ¡ãC. Distances (mm) from points to esophagus were 5.1 ¡À 0.6 (no rise), 4.2 ¡À 3.1 (38.0-38.9 ¡ãC), 2.9 ¡À 2.5 (¡Ý39.0 ¡ãC). Altogether, 15.5 % of points in the upper LA posterior wall, 41.5 % in the middle, and 30.2 % in the lower caused rises to ¡Ý38.0 ¡ãC; 8.7 % , 24.6 % , and 11.0 % caused rises to ¡Ý39.0 ¡ãC. The middle wall was most affected (p < 0.01), as shown by multiple logistic regression analysis (both temperatures). Points causing a rise increased significantly as distance decreased (p < 0.001). The odds ratio for rise to ¡Ý38.0 ¡ãC compared with <4.0 to >5.0 mm distance was 2.28 (p = 0.004). The longest distance for ¡Ý38.0 ¡ãC rise was 18.5 mm.

Conclusion

Distance is an important predictor of esophageal temperature rise. The middle LA posterior wall is most vulnerable. A dose of 15 W is too high for ablation, especially <4.0 mm from the esophagus. Points >20.0 mm away are relatively safe.