Division of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Bioengineering, University of Washington, Seattle, Washington, USA.
J Cardiovasc Electrophysiol. 2024 Apr;35(4):737-746. doi: 10.1111/jce.16213. Epub 2024 Feb 14.
Luminal esophageal temperature (LET) monitoring during atrial fibrillation (AF) ablation is widely used to reduce the incidence of endoscopically detected esophageal lesion (EDEL). We sought to assess whether specific patterns of LET variation are associated with EDEL.
A high-fidelity multisensor probe was used to record LET in AF patients undergoing radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Explainable machine learning and SHapley Additive exPlanations (SHAP) analysis were used to predict EDEL and assess feature importance.
A total of 94 patients (38.3% persistent AF, 71.3% male, 72 RFA, and 22 CBA) were included. EDEL was detected in 11 patients (10 RFA and one CBA). In the RFA group, the highest LET recorded was similar between patients with and without EDEL (40.6 [40.1-41]°C vs. 40.2 [39.1-40.9]°C; p = .313), however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03-0.12]°C/s vs. 0.02 [0.01-0.05]°C/s; p = .033), and the area under the curve (AUC) for the highest peak was smaller (412.5 [206.8-634.1] vs. 588.6 [380.4-861.1]; p = .047) in patients who had EDEL. In case of CBA, the patient with EDEL had a faster LET decline (0.12 vs. 0.07 [0.02-0.14]°C/s), and a smaller AUC for the lowest trough (2491.3 vs. 2629.3 [1712.6-5283.2]). SHAP analysis revealed that a rate of LET change higher than 0.05°C/s and an AUC less than 600 were more predictive of EDEL in RFA.
The rate of LET change and AUC for the recorded temperature predicted EDEL, whereas absolute peak temperatures did not.
在心房颤动（AF）消融期间，监测食管腔温度（LET）被广泛用于降低内镜检测到的食管损伤（EDEL）的发生率。我们旨在评估特定的 LET 变化模式是否与 EDEL 相关。
使用高保真多传感器探头记录接受射频消融（RFA）或冷冻球囊消融（CBA）的 AF 患者的 LET。使用可解释的机器学习和 SHapley Additive exPlanations（SHAP）分析来预测 EDEL 并评估特征重要性。
共纳入 94 例患者（持续性 AF 占 38.3%，男性占 71.3%，72 例行 RFA，22 例行 CBA）。11 例患者（10 例 RFA 和 1 例 CBA）检测到 EDEL。在 RFA 组中，有 EDEL 的患者与无 EDEL 的患者记录的最高 LET 相似（40.6[40.1-41]°C 比 40.2[39.1-40.9]°C；p=0.313），但记录到的最高峰值的 LET 上升率更高（0.08[0.03-0.12]°C/s 比 0.02[0.01-0.05]°C/s；p=0.033），最高峰值的 AUC 更小（412.5[206.8-634.1]比 588.6[380.4-861.1]；p=0.047）。在 CBA 的情况下，有 EDEL 的患者 LET 下降更快（0.12 比 0.07[0.02-0.14]°C/s），最低谷的 AUC 更小（2491.3 比 2629.3[1712.6-5283.2]）。SHAP 分析表明，LET 变化率高于 0.05°C/s 和 AUC 小于 600 对 RFA 中 EDEL 的预测更具预测性。
记录的温度的 LET 变化率和 AUC 可预测 EDEL，而绝对峰值温度则不能。
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