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应用第二代冷冻球囊评估左心房后壁消融术中食管腔内温度变化

Evaluation of the luminal esophageal temperature behavior during left atrium posterior wall ablation by means of second-generation cryoballoon.

作者信息

Osório Thiago Guimarães, Iacopino Saverio, Coutiño Hugo-Enrique, Ströker Erwin, Sieira Juan, Salghetti Francesca, Varnavas Varnavas, Terasawa Muryo, Paparella Gaetano, Capulzini Lucio, Maj Riccardo, De Greef Yves, Brugada Pedro, de Asmundis Carlo, Chierchia Gian-Battista

机构信息

Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium.

Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital GVM, Cotignola, Italy.

出版信息

J Interv Card Electrophysiol. 2019 Aug;55(2):191-196. doi: 10.1007/s10840-019-00523-0. Epub 2019 Feb 7.

DOI:10.1007/s10840-019-00523-0
PMID:30734138
Abstract

PURPOSE

The purpose of this study was to clarify the behavior of the luminal esophageal temperature (LET) in a cohort of patients undergoing second-generation cryoballoon (CB-A) for pulmonary vein isolation (PVI) and additional left atrium posterior wall (LAPW) ablation by means of CB-A.

METHODS

Thirty patients with symptomatic persistent AF (PersAF), having undergone PVI + LAPW cryoballoon ablation with LET monitoring.

RESULTS

Interruption of the application due to a LET below 15 °C occurred in 5 patients (16.6%), 2 at the LIPV and 3 in the LAPW. The 5 patients underwent gastroscopy the day after ablation. In all individuals, esophageal thermal lesion (ETL) was absent.

CONCLUSION

The evaluation of LET might be an additional tool in helping to prevent damage to the esophagus during the LAPW ablation with the CB-A by stopping the freeze application when temperature reaches values of < 15 °C.

摘要

目的

本研究旨在阐明在一组接受第二代冷冻球囊(CB-A)进行肺静脉隔离(PVI)及额外通过CB-A进行左心房后壁(LAPW)消融的患者中,食管腔内温度(LET)的变化情况。

方法

30例有症状的持续性房颤(PersAF)患者接受了PVI + LAPW冷冻球囊消融并进行LET监测。

结果

5例患者(16.6%)因LET低于15°C而中断操作,其中2例在左肺静脉,3例在左心房后壁。这5例患者在消融术后第二天接受了胃镜检查。所有个体均未出现食管热损伤(ETL)。

结论

对LET的评估可能是一种辅助工具,通过在温度低于15°C时停止冷冻操作,有助于在使用CB-A进行LAPW消融期间预防食管损伤。

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本文引用的文献

1
Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience.应用冷冻球囊行肺静脉隔离术联合环肺静脉消融术优于单纯肺静脉隔离术治疗持续性心房颤动:一项多中心经验。
Heart Rhythm. 2018 Aug;15(8):1121-1129. doi: 10.1016/j.hrthm.2018.05.014.
2
Atrioesophageal fistula formation with cryoballoon ablation is most commonly related to the left inferior pulmonary vein.冷冻球囊消融术后发生的心房食管瘘最常与左下肺静脉相关。
Heart Rhythm. 2017 Feb;14(2):184-189. doi: 10.1016/j.hrthm.2016.10.018. Epub 2016 Oct 18.
3
Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation.冷冻球囊消融左心房后壁联合肺静脉隔离的原理及结果
J Innov Card Rhythm Manag. 2021 Aug 15;12(8):4633-4646. doi: 10.19102/icrm.2021.120801. eCollection 2021 Aug.
4
Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique.比较冷冻球囊技术治疗阵发性心房颤动时在上腔静脉消融联合肺静脉隔离与标准肺静脉隔离的效果。
J Interv Card Electrophysiol. 2021 Dec;62(3):579-586. doi: 10.1007/s10840-020-00932-6. Epub 2021 Jan 15.
5
Left atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design.使用冷冻球囊进行左心房后壁隔离联合肺静脉隔离治疗持续性心房颤动(PIVoTAL):研究原理和设计。
J Interv Card Electrophysiol. 2021 Oct;62(1):187-198. doi: 10.1007/s10840-020-00885-w. Epub 2020 Oct 3.
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Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm.心房颤动后房性心动过速中新的非接触性电荷密度图:应用 Acutus SuperMap 算法的初步经验。
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Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up.第二代冷冻球囊消融治疗阵发性心房颤动:1 年随访。
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Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon.使用第二代 28 毫米冷冻球囊导致食管热损伤发生率增加。
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