Velasco Alejandro, Buch Chirag, Hui Dawn, Joseph Christopher, Onsager David, Zagrodzky William, Kulstad Erik, Nayak Hemal M
Division of Cardiology, University of Texas Health, San Antonio, TX, USA.
Division of Cardiothoracic Surgery, University of Texas Health, San Antonio, TX, USA.
Eur Heart J Case Rep. 2024 Jun 12;8(7):ytae301. doi: 10.1093/ehjcr/ytae301. eCollection 2024 Jul.
The hybrid convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal oesophageal temperature (LET) monitoring, oesophageal injury is still possible. A dedicated device for proactive oesophageal cooling has recently been cleared by the Food and Drug Administration to reduce the likelihood of ablation-related oesophageal injury resulting from radiofrequency cardiac ablation procedures. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of hybrid convergent procedures.
Five patients with long-standing persistent AF underwent hybrid convergent ablations with the use of proactive oesophageal cooling as means of oesophageal protection. All cases were completed successfully with no adverse effects. Most notably, cases were shorter when compared to cases using LET monitoring, likely due to lack of pauses for overheating of the oesophagus that would otherwise be required to prevent damage to the oesophagus.
This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of five hybrid convergent procedures. Use of cooling enabled uninhibited deployment of lesions without the need to pause energy delivery due to elevated temperatures in the oesophagus, providing a feasible alternative to LET monitoring.
杂交消融术已被批准用于治疗长期持续性心房颤动（AF）的症状性患者。尽管在手术消融过程中可直接观察，且使用了食管腔内温度（LET）监测，但食管损伤仍有可能发生。美国食品药品监督管理局最近批准了一种专门用于主动食管冷却的设备，以降低射频心脏消融手术导致的与消融相关的食管损伤的可能性。本报告描述了在杂交消融术的心外膜消融部分首次使用主动食管冷却来保护食管的情况。
5例长期持续性AF患者接受了杂交消融术，并使用主动食管冷却作为食管保护手段。所有病例均成功完成，无不良反应。最值得注意的是，与使用LET监测的病例相比，这些病例的手术时间更短，这可能是因为无需因食管过热而暂停手术，否则为防止食管损伤就需要这样做。
本报告描述了在5例杂交消融术的心外膜消融部分首次使用主动食管冷却来保护食管的情况。使用冷却能够在不因为食管温度升高而暂停能量输送的情况下无限制地进行消融，为LET监测提供了一种可行的替代方法。
