Tsuchiya Takeshi, Ashikaga Keiichi, Nakagawa Susumu, Hayashida Kiyoshi, Kugimiya Hiroshi
Division of Cardiology, Hakuaikai Hospital, Kumamoto, Japan.
J Cardiovasc Electrophysiol. 2007 Feb;18(2):145-50. doi: 10.1111/j.1540-8167.2006.00693.x. Epub 2006 Dec 1.
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).
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.
Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.
左心房食管瘘是心房颤动（AF）消融过程中一种罕见但极具破坏性的并发症，可能是由于射频（RF）消融过程中发生的热损伤所致。我们研究了使用水冷式食管内球囊（IB）进行食管冷却（ECO）方法的可行性。
8例药物难治性AF患者接受了RF导管消融以环绕同侧肺静脉。在左心房后壁进行RF消融期间，使用一根9F的IB导管冷却食管腔，该导管球囊长度为40mm，直径为10mm，在通过置于靠近消融导管尖端部位的食管内探头测量食管腔内温度（LET）的同时，灌注水温为4.5±3.1℃的冷水。对照组中，在3.9±1.2次RF能量应用期间，LET在26.1±8.2秒内从36.4±0.8℃升至40.5±1.7℃，而采用ECO时，LET在基线时降至30.2±2.9℃（与对照组相比，P<0.01），在3.9±1.2次RF能量应用期间最多在30秒内仅升至33.5±2.9℃（与对照组相比，P<0.01）。所有患者的所有肺静脉均成功隔离，无任何并发症。在3.1±1.2个月的随访期内，未观察到食管损伤，除1例患者外，所有患者均无症状。
使用IB成功降低了LET。这可能具有预防食管损伤的潜力，尽管还需要进一步研究。
