Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases
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| Format: | Artículo científico |
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Sociedade Brasileira de Cirurgia Cardiovascular
2015
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| _version_ | 1876442418049449984 |
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| author | José Carlos Pachón Mateos |
| author_facet | José Carlos Pachón Mateos |
| contents | Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases José Carlos Pachón Mateos Enrique I Pachón Mateos Tomas G Santillana Peña Tasso Julio Lobo Juán Carlos Pachón Mateos Remy Nelson A Vargas Carlos Thiene C Pachón Juán Carlos Zerpa Acosta Medicina Esophagus Catheter Ablation Esophageal Fistula Atrial Fibrillation Introduction: Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality . Objective: This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibril - lation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. Methods: Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8±14 [17-84] years old), with mean EF of 0.66±0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmo - nary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiog - raphy transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. Results: The mean esophageal displacement was 4 to 9.1cm (5.9±0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40 o C/irri - gated catheter or 50W/60 o C/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11±0.13 o C versus 1.1±0.4 o C respectively, P <0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echo - cardiography transducer insertion were observed. Conclusion: Mechanical esophageal displacement by transe - sophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid esophageal thermal lesion. In most cases, the esophageal displacement was sufficient to allow safe ra - diofrequency application without esophagus overlapping, being a convenient alternative in reducing the risk of atrioesophageal fistula. 2015 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941897003 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.2 Vol.30 |
| format | Artículo científico |
| id | redalyc_398941897003 |
| institution | Redalyc |
| language | en |
| publishDate | 2015 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases José Carlos Pachón Mateos Medicina Esophagus Catheter Ablation Esophageal Fistula Atrial Fibrillation Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases José Carlos Pachón Mateos Enrique I Pachón Mateos Tomas G Santillana Peña Tasso Julio Lobo Juán Carlos Pachón Mateos Remy Nelson A Vargas Carlos Thiene C Pachón Juán Carlos Zerpa Acosta Medicina Esophagus Catheter Ablation Esophageal Fistula Atrial Fibrillation Introduction: Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality . Objective: This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibril - lation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. Methods: Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8±14 [17-84] years old), with mean EF of 0.66±0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmo - nary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiog - raphy transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. Results: The mean esophageal displacement was 4 to 9.1cm (5.9±0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40 o C/irri - gated catheter or 50W/60 o C/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11±0.13 o C versus 1.1±0.4 o C respectively, P <0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echo - cardiography transducer insertion were observed. Conclusion: Mechanical esophageal displacement by transe - sophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid esophageal thermal lesion. In most cases, the esophageal displacement was sufficient to allow safe ra - diofrequency application without esophagus overlapping, being a convenient alternative in reducing the risk of atrioesophageal fistula. 2015 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941897003 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.2 Vol.30 |
| title | Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases |
| topic | Medicina Esophagus Catheter Ablation Esophageal Fistula Atrial Fibrillation |
| url | https://www.redalyc.org/articulo.oa?id=398941897003 |