Department of Emergency Medicine, University of Texas Southwestern Medical Center.
Department of Internal Medicine, University of Texas Southwestern Medical Center.
J Vis Exp. 2022 Aug 25(186). doi: 10.3791/64417.
Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the esophagus from inadvertent thermal injury. Active esophageal cooling is increasingly being used over traditional luminal esophageal temperature (LET) monitoring, and each approach may influence procedure times and the variability around those times. The objective of this study is to measure the effects on procedure time and variability in procedure time of two different esophageal protection strategies utilizing advanced informatics techniques to facilitate data extraction. Trained clinical informaticists first performed a contextual inquiry in the catheterization laboratory to determine laboratory workflows and observe the documentation of procedural data within the electronic health record (EHR). These EHR data structures were then identified in the electronic health record reporting database, facilitating data extraction from the EHR. A manual chart review using a REDCap database created for the study was then performed to identify additional data elements, including the type of esophageal protection used. Procedure duration was then compared using summary statistics and standard measures of dispersion. A total of 164 patients underwent radiofrequency PVI over the study timeframe; 63 patients (38%) were treated with LET monitoring, and 101 patients (62%) were treated with active esophageal cooling. The mean procedure time was 176 min (SD of 52 min) in the LET monitoring group compared to 156 min (SD of 40 min) in the esophageal cooling group (P = 0.012). Thus, active esophageal cooling during PVI is associated with reduced procedure time and reduced variation in procedure time when compared to traditional LET monitoring.
在射频（RF）肺静脉隔离（PVI）治疗心房颤动（AF）过程中，使用各种方法来保护食管免受意外热损伤。主动食管冷却技术在传统的腔内食管温度（LET）监测中得到越来越多的应用，每种方法可能会影响手术时间及其变异性。本研究的目的是利用先进的信息学技术来衡量两种不同食管保护策略对手术时间及其变异性的影响，以方便数据提取。训练有素的临床信息学家首先在导管实验室进行了背景调查，以确定实验室工作流程，并观察电子病历（EHR）中程序性数据的记录。然后在电子病历报告数据库中确定这些 EHR 数据结构，以便从 EHR 中提取数据。然后使用为研究创建的 REDCap 数据库进行手动图表审查，以识别其他数据元素，包括使用的食管保护类型。然后使用汇总统计和标准离散度指标比较手术持续时间。在研究期间，共有 164 例患者接受了射频 PVI 治疗；63 例（38%）患者接受 LET 监测治疗，101 例（62%）患者接受主动食管冷却治疗。在 LET 监测组，手术时间的平均值为 176 分钟（52 分钟的标准差），而在食管冷却组为 156 分钟（40 分钟的标准差）（P = 0.012）。因此，与传统的 LET 监测相比，PVI 期间主动食管冷却与手术时间缩短和手术时间变异性降低有关。
