Chen Hongwu, Liu Qiang, Shehata Michael, Ma Wei, Xu Jing, Cao Jianing, Cingolani Eugenio, Ehdaie Ashkan, Jiang Chenyang, Chen Minglong, Chugh Sumeet S, Wang Xunzhang
Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.
Pacing Clin Electrophysiol. 2019 Sep;42(9):1169-1174. doi: 10.1111/pace.13767. Epub 2019 Aug 8.
Esophageal injury is related to a reduction in luminal esophageal temperature (LET) in second-generation cryoballoon (CB) ablation; however, methods to prevent these reductions in temperature have not been well characterized.
Esophageal temperature was continuously monitored using a LET probe in patients undergoing pulmonary vein (PV) isolation using the second-generation CB. A rotational maneuver of the CB was performed if the initial ablation resulted in a decrease of more than 4℃ in LET. The refrigerant injector near the distal CB pole was used as a fluoroscopic marker to measure the nearest distance between the CB and the LET probe.
A total of 52 consecutive patients were enrolled in this study. The rotation was applied in 19 patients and 20 PVs (seven left superior pulmonary veins [LSPVs], seven left inferior PVs [LIPVs], and six right inferior PVs [RIPVs]) with a reduction in LET of more than 4℃ during freezing. The nadir temperature of CB applications was similar before and after CB rotation in all PVs. There was significant difference in the minimum LET before and after rotation during freezing in LSPVs (28.4 ± 3.7 vs 32.4 ± 2.3℃, P = .02), LIPVs (28.4 ± 1.4 vs 32.6 ± 2.7, P = .01) and RIPVs (26.1 ± 4.3 vs 34.0 ± 1.3℃, P = .002). The differences in mean balloon to LET distance were measured for all veins before and after rotation; LSPV (right anterior oblique [RAO], 11.0 ± 1.7 vs 13.8 ± 4.5 mm, P = .05); LIPV (RAO, 10.7 ± 4.3 vs 14.6 ± 6.1 mm, P = .03); RIPV (LAO, 11.8 ± 5.5 vs 14.2 ± 5.7 mm, P = .01).
CB rotational maneuvers during ablation can prevent significant reduction in LET and may prevent esophageal injury during the procedure.
在第二代冷冻球囊（CB）消融术中，食管损伤与食管腔内温度（LET）降低有关；然而，预防这些温度降低的方法尚未得到充分描述。
在使用第二代CB进行肺静脉（PV）隔离的患者中，使用LET探头连续监测食管温度。如果初始消融导致LET下降超过4℃，则对CB进行旋转操作。CB远端极附近的制冷剂注射器用作透视标记，以测量CB与LET探头之间的最近距离。
本研究共纳入52例连续患者。19例患者和20条PV（7条左上肺静脉[LSPV]、7条左下肺静脉[LIPV]和6条右下肺静脉[RIPV]）在冷冻期间LET下降超过4℃时应用了旋转操作。所有PV在CB旋转前后CB应用的最低温度相似。LSPV（28.4±3.7 vs 32.4±2.3℃，P = 0.02）、LIPV（28.4±1.4 vs 32.6±2.7，P = 0.01）和RIPV（26.1±4.3 vs 34.0±1.3℃，P = 0.002）在冷冻期间旋转前后的最低LET存在显著差异。测量了所有静脉在旋转前后球囊与LET的平均距离差异；LSPV（右前斜位[RAO]，11.0±1.7 vs 13.8±4.5 mm，P = 0.05）；LIPV（RAO，10.7±4.3 vs 14.6±6.1 mm，P = 0.03）；RIPV（左前斜位[LAO]，11.8±5.5 vs 14.2±5.7 mm，P = 0.01）。
消融过程中CB旋转操作可防止LET显著降低，并可能预防术中食管损伤。
