John Jinu, Garg Lohit, Orosey Molly, Desai Tusar, Haines David E, Wong Wai Shun
Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
J Interv Card Electrophysiol. 2020 Jun;58(1):43-50. doi: 10.1007/s10840-019-00566-3. Epub 2019 Jun 1.
Catheter ablation of atrial fibrillation (AF) may lead to collateral damage to the esophagus. We tested the hypothesis that luminal esophageal temperature (LET)-guided esophageal cooling might reduce the incidence of esophageal thermal lesions (ETL).
Seventy-six patients from August 2015 to March 2017 with paroxysmal or persistent AF underwent a first-time catheter ablation procedure with or without LET-guided active esophageal cooling through an orogastric tube placed in the esophagus. Esophageal cooling occurred if and only if LET exceeded 0.5 °C from baseline while ablating the LA posterior wall. All patients underwent esophagogastric endoscopy the next day.
Of the 76 patients studied, 38 (50%) patients underwent esophageal cooling. Baseline characteristics of the non-cooled and cooled groups were comparable. Of these, 59% of patients had ETL. There was a non-significant trend for more severe lesions (grades 3, 4) in the non-cooled group (29% vs. 13.5%, p = 0.10). Average power delivered on the left atrial posterior wall (27 ± 1.8 W vs. 27 ± 3.8 W, p = 0.34) and average force of contact (10.1 g vs. 9.8 g, p = 0.38) were similar in both groups while more time was spent ablating on the posterior wall in the non-cooled group (24.6 ± 7.3 min vs. 20.4 ± 5.9 min, p = 0.014). In a multivariate analysis, esophageal cooling had no significant effect on the esophageal lesion grade post-ablation.
The incidence of ETL in patients undergoing left atrial posterior wall isolation is substantial. Our method of esophageal cooling did not decrease the incidence of ETL. There was a non-significant trend toward fewer severe lesions with cooling, but one cannot conclude the value of cooling from this pilot study.
心房颤动（AF）导管消融术可能会导致食管受到附带损伤。我们检验了这样一个假设，即管腔内食管温度（LET）引导下的食管冷却可能会降低食管热损伤（ETL）的发生率。
2015年8月至2017年3月期间，76例阵发性或持续性AF患者首次接受导管消融手术，术中通过放置在食管内的鼻胃管进行或不进行LET引导下的主动食管冷却。仅当在消融左心房后壁时LET较基线升高超过0.5°C时才进行食管冷却。所有患者在次日接受食管胃内镜检查。
在研究的76例患者中，38例（50%）患者接受了食管冷却。未冷却组和冷却组的基线特征具有可比性。其中，59%的患者有ETL。未冷却组中更严重损伤（3级、4级）的趋势不显著（29%对13.5%，p = 0.10）。两组在左心房后壁施加的平均功率（27±1.8W对27±3.8W，p = 0.34）和平均接触力（10.1g对9.8g，p = 0.38）相似，而未冷却组在左心房后壁消融的时间更长（24.6±7.3分钟对20.4±5.9分钟，p = 0.014）。在多变量分析中，食管冷却对消融后食管损伤分级无显著影响。
接受左心房后壁隔离术的患者中ETL的发生率很高。我们的食管冷却方法并未降低ETL的发生率。冷却后严重损伤减少的趋势不显著，但无法从这项初步研究得出冷却的价值。
