Miyazaki Shinsuke, Nakamura Hiroaki, Taniguchi Hiroshi, Hachiya Hitoshi, Takagi Takamitsu, Igarashi Miyako, Kajiyama Takatsugu, Watanabe Tomonori, Niida Takashi, Hirao Kenzo, Iesaka Yoshito
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Heart Rhythm. 2017 May;14(5):670-677. doi: 10.1016/j.hrthm.2017.01.028.
Few data are available on gastric hypomotility (GH) after cryoballoon pulmonary vein isolation. Also, the use of esophageal temperature monitoring for the prevention of endoscopically detected esophageal lesions (EDELs) is not well established.
The purpose of this study was to investigate GH and the impact of an esophageal probe on EDELs during second-generation cryoballoon ablation.
One hundred four patients with paroxysmal atrial fibrillation undergoing second-generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Temperature probes were used in the first 40 (38.5%) patients, but not in the latter 64 (61.5%). Pulmonary vein isolation was performed with one 28-mm balloon using single 3-minute freeze techniques.
Clinical and procedural characteristics were similar between the groups. Esophagogastroscopy 1.4 ± 0.5 days postablation demonstrated GH and EDELs in 18 (17.3%) and 9 (8.7%) patients. The incidence of GH was similar (7 of 40 vs 11 of 64; P = .967) between the groups, while that of EDELs was significantly higher in the former than in the latter group (8 of 40 vs 1 of 64; P < .0001). In multivariate analyses, the esophagus-right inferior pulmonary vein ostium distance (hazard ratio 0.870; 95% confidence interval 0.798-0.948; P = .002) was the sole predictor of GH, and the optimal cutoff for the prediction was 18.2 mm (sensitivity 88.1%; specificity 77.8%). The use of esophageal probes was the sole predictor of EDELs (hazard ratio 15.750; 95% confidence interval 1.887-131.471; P = .011). All collateral damage was asymptomatic and healed on repeat esophagogastroscopy at a mean of 2 ± 1 months postprocedure.
Second-generation cryoballoon ablation is associated with an increased incidence of silent periesophageal nerve injury even using short freeze times, and anatomical information aids identifying high-risk populations. The use of esophageal probes increases the risk of EDELs.
关于冷冻球囊肺静脉隔离术后胃动力不足（GH）的数据较少。此外，使用食管温度监测预防内镜下检测到的食管病变（EDELs）尚未得到充分证实。
本研究旨在调查第二代冷冻球囊消融术中的GH情况以及食管探头对EDELs的影响。
前瞻性纳入104例在清醒镇静下接受第二代冷冻球囊消融术并随后接受食管胃镜检查的阵发性心房颤动患者。前40例（38.5%）患者使用了温度探头，后64例（61.5%）患者未使用。采用单个28 mm球囊，单次3分钟冷冻技术进行肺静脉隔离。
两组患者的临床和手术特征相似。消融术后1.4±0.5天的食管胃镜检查显示，18例（17.3%）患者出现GH，9例（8.7%）患者出现EDELs。两组间GH的发生率相似（40例中的7例 vs 64例中的11例；P = 0.967），而EDELs的发生率在前一组显著高于后一组（40例中的8例 vs 64例中的1例；P < 0.0001）。在多因素分析中，食管与右下肺静脉口的距离（风险比0.870；95%置信区间0.798 - 0.948；P = 0.002）是GH的唯一预测因素，预测的最佳截断值为18.2 mm（敏感性88.1%；特异性77.8%）。使用食管探头是EDELs的唯一预测因素（风险比15.750；95%置信区间1.887 - 131.471；P = 0.011）。所有的附带损伤均无症状，在术后平均（2±1）个月复查食管胃镜时愈合。
即使使用较短的冷冻时间，第二代冷冻球囊消融术也与无症状的食管周围神经损伤发生率增加相关，解剖学信息有助于识别高危人群。使用食管探头会增加EDELs的风险。
