Neven Kars, van Es René, van Driel Vincent, van Wessel Harry, Fidder Herma, Vink Aryan, Doevendans Pieter, Wittkampf Fred
From the Departments of Cardiology (K.N., R.v.E., V.v.D., H.v.W., P.D., F.W.), Gastroenterology (H.F.), and Pathology (A.V.), University Medical Center Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen (K.N.); Witten/Herdecke University, Germany (K.N.); St Jude Medical, Veenendaal (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.D.).
Circ Arrhythm Electrophysiol. 2017 May;10(5). doi: 10.1161/CIRCEP.116.004672.
Esophageal ulceration and fistula are complications of pulmonary vein isolation using thermal energy sources. Irreversible electroporation is a novel, nonthermal ablation modality for pulmonary vein isolation. A single 200 J application can create deep myocardial lesions. Acute and chronic effects of this new energy source on the esophagus are unknown.
In 8 pigs (±70 kg), the suprasternal esophagus was surgically exposed. A linear suction device with a single 35-mm long and 6-mm wide protruding linear electrode inside a plastic suction cup was used for ablation. Single, nonarcing, nonbarotraumatic, cathodal 100 and 200 J applications were delivered at 2 different sites on the anterior esophageal adventitia. No proton-pump inhibitors were administered during follow-up. Esophagoscopy was performed at days 2 and 7. After euthanasia at day 60, the esophagus was evaluated visually and histologically. All ablations were uneventful. Esophagoscopy at day 2 showed small white densities in the ablated areas, which appeared to be small intraepithelial vesicles. No epithelial erythema, erosions, or ulcerations were seen. At day 7, all densities had disappeared, and all esophaguses appeared completely normalized. After euthanasia, there were no macroscopically visible lesions on the adventitia or epithelium. Histologically, a small scar was observed at the outer part of the muscular layer, whereas the mucosa and submucosa were normal.
Esophageal architecture remains unaffected 2 months after irreversible electroporation, purposely targeting the adventitia. Irreversible electroporation seems to be a safe modality for catheter ablation near the esophagus.
食管溃疡和瘘管是使用热能源进行肺静脉隔离的并发症。不可逆电穿孔是一种用于肺静脉隔离的新型非热消融方式。单次施加200焦耳能量可造成深部心肌损伤。这种新能量源对食管的急性和慢性影响尚不清楚。
在8头猪（体重约70千克）中，通过手术暴露胸骨上食管。使用一种线性抽吸装置，其塑料抽吸杯内有一个35毫米长、6毫米宽的突出线性电极，用于消融。在食管前外膜的2个不同部位分别施加单次、无电弧、无气压伤的阴极100焦耳和200焦耳能量。随访期间未给予质子泵抑制剂。在第2天和第7天进行食管镜检查。在第60天实施安乐死后，对食管进行肉眼和组织学评估。所有消融操作均顺利进行。第2天的食管镜检查显示消融区域有小的白色致密影，似乎是小的上皮内小泡。未见上皮红斑、糜烂或溃疡。第7天，所有致密影均消失，所有食管外观完全恢复正常。安乐死后，外膜或上皮未见肉眼可见的病变。组织学检查显示，肌层外部有小瘢痕，而黏膜和黏膜下层正常。
在不可逆电穿孔特意针对外膜2个月后，食管结构未受影响。不可逆电穿孔似乎是一种在食管附近进行导管消融的安全方式。
