Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology; University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
Heart Rhythm. 2015 Jul;12(7):1464-9. doi: 10.1016/j.hrthm.2015.04.005. Epub 2015 Apr 3.
Endoscopically detected esophageal lesions (EDELs) have been identified in apparently asymptomatic patients after catheter ablation of atrial fibrillation (AF). The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial.
The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs.
Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation.
Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P < .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P < .01).
The use of esophageal temperature probes in the setting of AF catheter ablation per se appears to be a risk factor for the development of EDEL.
在房颤（AF）导管消融后，在无症状患者中发现了内镜下食管病变（EDEL）。目前对于在导管消融过程中使用食管探头监测管腔食管温度（LET）以保护食管损伤存在争议。
本研究旨在探讨在 AF 导管消融过程中使用食管温度探头对 EDEL 发生率的影响。
连续纳入 80 例接受左心房射频导管消融的有症状、药物难治性阵发性（n = 52，65%）或持续性 AF 患者（平均年龄 63.8 ± 11.36 岁；68.8%为男性）。后壁消融采用功率限制（≤25 W）。在前 40 例患者中，连续监测 LET（A 组），而 B 组（n = 40 例）未使用食管温度探头。在射频导管消融后 2 天内行内镜评估 EDEL。
总体而言，13 例（16%）患者在 AF 消融后出现 EDEL。A 组 EDEL 的发生率明显高于 B 组（30%比 2.5%，P <.01）。在 A 组中，发生 EDEL 的患者在 AF 消融过程中 LET 最大值高于未发生 EDEL 的患者（40.97 ± 0.92°C 比 40.14 ± 1.1°C，P =.02）。多变量逻辑回归分析显示，使用食管温度探头是 EDEL 发生的唯一独立预测因素（优势比 16.7，P <.01）。
AF 导管消融过程中使用食管温度探头本身似乎是 EDEL 发生的危险因素。
