Kiuchi Kunihiko, Okajima Katsunori, Shimane Akira, Kanda Gaku, Yokoi Kiminobu, Teranishi Jin, Aoki Kousuke, Chimura Misato, Toba Takayoshi, Oishi Shogo, Sawada Takahiro, Tsukishiro Yasue, Onishi Tetsuari, Kobayashi Seiichi, Taniguchi Yasuyo, Yamada Shinichiro, Yasaka Yoshinori, Kawai Hiroya, Yoshida Akihiro, Fukuzawa Koji, Itoh Mitsuaki, Imamura Kimitake, Fujiwara Ryudo, Suzuki Atsushi, Nakanishi Tomoyuki, Yamashita Soichiro, Hirata Ken-Ichi, Tada Hiroshi, Yamasaki Hiro, Naruse Yoshihisa, Igarashi Miyako, Aonuma Kazutaka
Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
J Arrhythm. 2016 Feb;32(1):36-41. doi: 10.1016/j.joa.2015.07.003. Epub 2015 Sep 16.
Even with the use of a reduced energy setting (20-25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking.
This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m(2)). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI).
The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00).
Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI.
即使使用降低的能量设置（20 - 25瓦），据报道，房颤（AF）导管消融术后仍有10%的患者会发生透壁性损伤（ETI）。然而，ETI的发生率取决于肺静脉隔离（PVI）方法及其食管温度监测设置。目前仍缺乏比较有和没有食管温度监测（ETM）的房颤消融术后ETI发生率的数据。
本研究纳入了160例房颤患者（54%为阵发性房颤，平均体重指数：24.0±2.9kg/m²）。80例患者在ETM辅助下进行消融。主要终点定义为房颤消融术后5天内通过内镜评估的ETI发生情况。次要终点定义为单次手术后房颤复发。如果食管温度探头记录的温度>39°C，立即停止射频（RF）应用。RF应用可逐点进行，最长持续20秒，功率为20瓦。ETI定义为房颤消融导致的任何损伤，包括食管损伤或食管周围神经损伤（peri - ENI）。
与未进行ETM的患者相比，进行房颤消融且包含ETM的患者食管损伤发生率显著更低（0[0%] vs. 6[7.5%]，p = 0.028），但peri - ENI的发生率并非如此（2[2.5%] vs. 3[3.8%]，p = 1.0）。两组术后12个月的房颤复发情况相似（ETM组为20[25%]，非ETM组为19[24%]，p = 1.00）。
使用ETM进行导管消融可降低食管损伤的发生率，且不增加房颤复发率，但不能降低peri - ENI的发生率。
