Shigeta Takatoshi, Okishige Kaoru, Aoyagi Hideshi, Nishimura Takuro, Nakamura Rena A, Ito Naruhiko, Tsuchiya Yusuke, Asano Mitsutoshi, Shimura Tsukasa, Suzuki Hidetoshi, Kurabayashi Manabu, Fukami Yuichi, Sakita Shinya, Keida Takehiko, Sasano Tetsuo, Hirao Kenzo, Yamauchi Yasuteru
Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Pacing Clin Electrophysiol. 2019 Feb;42(2):230-237. doi: 10.1111/pace.13578. Epub 2019 Jan 2.
The cryoballoon (CB) can be utilized for extra pulmonary vein (PV) ablation such as for a left atrial (LA) posterior wall (LAPW) isolation. However, scrutiny of the esophageal injuries during the LAPW isolation has never been performed. We sought to thoroughly investigate the esophageal lesions (ELs) and gastric hypomotility (GH) caused by an LAPW isolation using a CB.
A total of 101 persistent atrial fibrillation patients who underwent an LAPW isolation using a CB were enrolled. The CB was applied on the roof and bottom area of the LAPW after a PV isolation. The luminal esophageal temperature (LET) was monitored by a thermistor probe during the CB applications. When the LET reached 15°C, the freezing application was prematurely interrupted. Esophagogastroscopy was performed on the next day following the ablation.
All PVs were successfully isolated in all patients. A successful LAPW isolation solely with CB ablation was performed in 72 (71.3%) patients. Cryofreezing applications were prematurely interrupted due to low LETs in 49 (48.5%) patients predominantly during the LA bottom line ablation. ELs and GH were observed in 11 (10.9%) and 16 patients (15.8%), respectively. The nadir LET tended to be lower in patients with ELs and GH than in those without (ELs: 14.8 ± 4.5°C vs 17.4 ± 6.0°C, P = 0.17; GH: 15.5 ± 4.5°C vs 17.5 ± 6.1°C, P = 0.23, respectively).
Esophageal complications such as ELs and GH occur during the LAPW isolation with a CB. There was no reliable predictor of those adverse events.
冷冻球囊（CB）可用于肺静脉（PV）外消融，如左心房（LA）后壁（LAPW）隔离。然而，从未对LAPW隔离期间的食管损伤进行过仔细检查。我们试图彻底研究使用CB进行LAPW隔离所导致的食管病变（ELs）和胃动力减退（GH）。
共纳入101例接受使用CB进行LAPW隔离的持续性房颤患者。在PV隔离后，将CB应用于LAPW的顶部和底部区域。在应用CB期间，通过热敏电阻探头监测食管腔内温度（LET）。当LET达到15°C时，提前中断冷冻应用。消融术后次日进行食管胃镜检查。
所有患者的所有PV均成功隔离。仅通过CB消融成功进行LAPW隔离的患者有72例（71.3%）。49例（48.5%）患者因LET较低而提前中断冷冻应用，主要发生在LA底线消融期间。分别在11例（10.9%）和16例（15.8%）患者中观察到ELs和GH。有ELs和GH的患者的最低LET往往低于无ELs和GH的患者（ELs：14.8±4.5°C对17.4±6.0°C，P = 0.17；GH：15.5±4.5°C对17.5±6.1°C，P = 0.23）。
在使用CB进行LAPW隔离期间会发生ELs和GH等食管并发症。对于这些不良事件，没有可靠的预测指标。
