Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Division of Cardiology, Department of Internal Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2021 Jul;32(7):1857-1864. doi: 10.1111/jce.15097. Epub 2021 May 28.
Esophageal injury during atrial fibrillation (AF) ablation is a life-threatening complication. We sought to measure the association of esophageal temperature attenuation with radiofrequency (RF) electrode impedance, contact force, and distance from the esophagus.
The retrospective study cohort included 35 patients with mean age 64 ± 10 years, of whom 74.3% were male, and 40% had persistent AF. All patients had undergone preprocedural cardiac magnetic resonance (CMR) followed by AF ablation with luminal esophageal temperature monitoring. Lesion locations were co-registered with CMR image segmentations of left atrial and esophageal anatomy. Luminal esophageal temperature, time matched RF lesion data, and ablation distance from the nearest esophageal location were collected as panel data.
Luminal esophageal temperature changes corresponding to 3667 distinct lesions, delivered with mean power 27.9 ± 5.5 W over a mean duration of 22.2 ± 10.5 s were analyzed. In multivariable analyses, clustered per patient, examining posterior wall lesions only, and adjusted for lesion power and duration as set by the operator, lesion distance from the esophagus (-0.003°C/mm, p < .001), and baseline impedance (-0.015°C/Ω, p < .001) were associated with changes in luminal esophageal temperature.
Esophageal luminal temperature rises are associated with shorter lesion distance from esophagus and lower baseline impedance during RF lesion delivery. When procedural strategy requires RF delivery near the esophagus, selection of sites with higher baseline impedance may improve safety.
心房颤动（AF）消融过程中的食管损伤是一种危及生命的并发症。我们旨在测量食管温度衰减与射频（RF）电极阻抗、接触力以及与食管距离的相关性。
这项回顾性研究队列纳入了 35 名平均年龄 64±10 岁的患者，其中 74.3%为男性，40%为持续性 AF。所有患者均接受了术前心脏磁共振（CMR）检查，随后进行了管腔内食管温度监测下的 AF 消融。病变部位与左心房和食管解剖结构的 CMR 图像分割进行了配准。收集了管腔内食管温度、与时间匹配的 RF 病变数据以及距最近食管位置的消融距离作为面板数据。
对 3667 个不同病变进行了管腔内食管温度变化分析，这些病变使用平均功率 27.9±5.5 W 进行了治疗，平均持续时间为 22.2±10.5 秒。在多变量分析中，对每个患者进行聚类分析，仅检查后壁病变，并根据操作者设定的病变功率和持续时间进行调整，食管距离病变（-0.003°C/mm，p<0.001）和基线阻抗（-0.015°C/Ω，p<0.001）与管腔内食管温度的变化相关。
在 RF 病变输送过程中，食管管腔内温度升高与距食管更近的病变距离和更低的基线阻抗相关。当程序策略需要在靠近食管的部位进行 RF 输送时，选择基线阻抗较高的部位可能会提高安全性。
