Iwasaki Yu-Ki, Fujimoto Yuhi, Oka Eiichiro, Ito Hagiwara Kanako, Takahashi Kenta, Tsuboi Ippei, Hayashi Hiroshi, Yodogawa Kenji, Hayashi Meiso, Miyauchi Yasushi, Shimizu Wataru
The Department of Cardiovascular Medicine, Nippon Medical School, Japan.
Department of Cardiovascular Medicine, Nippon Medical School Musashikosugi Hospital, Japan.
Int J Cardiol Heart Vasc. 2021 Mar 27;33:100771. doi: 10.1016/j.ijcha.2021.100771. eCollection 2021 Apr.
Respiratory management during catheter ablation of atrial fibrillation (AF) is important for the efficacy and safety of the procedure. Obstructive apnea due to an upper airway obstruction might cause serious complications including air embolisms and cardiac tamponade. However, real time monitoring of upper airway obstructions during catheter ablation has not been established. The purpose of the present study was to evaluate esophageal pressure monitoring for respiratory management during catheter ablation of AF.
Twenty-four consecutive patients (20 men and 4 women; mean age, 61 ± 13 years) with AF who underwent esophageal pressure monitoring during catheter ablation of AF were retrospectively analyzed. The patients were divided into 2 groups. One was the obstructive apnea (OA) group (n = 17), which required airway management tools including nasal airways and/or non-invasive positive airway pressure (NPPV) and the other was the control group (n = 7), which did not require airway management. Esophageal pressure measurements were obtained in all patients, and the OA group exhibited a substantial negative esophageal pressure as compared to the control group (-41.48 ± 19.58 vs. -12.42 ± 5.77 mmHg, p < 0.001). Airway management in the OA group immediately improved the negative esophageal pressure and returned to a normal range (-41.48 ± 19.58 vs. -16 ± 8.1 mmHg, 0 < 0.001) along with a recovery from desaturation.
Esophageal pressure monitoring was a simple and effective method for the evaluation and management of obstructive apnea during AF catheter ablation.
心房颤动（AF）导管消融术中的呼吸管理对于手术的疗效和安全性至关重要。上呼吸道阻塞导致的阻塞性呼吸暂停可能会引起严重并发症，包括空气栓塞和心脏压塞。然而，导管消融术中对上呼吸道阻塞的实时监测尚未确立。本研究的目的是评估食管压力监测在AF导管消融术中用于呼吸管理的效果。
对24例在AF导管消融术中接受食管压力监测的连续AF患者（20例男性和4例女性；平均年龄61±13岁）进行回顾性分析。患者分为两组。一组为阻塞性呼吸暂停（OA）组（n = 17），需要包括鼻气道和/或无创正压通气（NPPV）在内的气道管理工具；另一组为对照组（n = 7），不需要气道管理。所有患者均进行了食管压力测量，与对照组相比，OA组的食管压力显著为负（-41.48±19.58 vs. -12.42±5.77 mmHg，p < 0.001）。OA组的气道管理立即改善了食管负压，并恢复到正常范围（-41.48±19.58 vs. -16±8.1 mmHg，p < 0.001），同时饱和度恢复正常。
食管压力监测是评估和管理AF导管消融术中阻塞性呼吸暂停的一种简单有效的方法。
