Kayani Waqas, Schricker Amir A, Nerlekar Ridhima, Earnest Brooke, Hongo Richard, Hao Steven, Woods Christopher
Internal Medicine, Sutter Health, San Francisco, CA, USA.
Atrial Fibrillation and Complex Arrhythmia Center, Sutter California Pacific Medical Center, San Francisco, CA, USA.
J Interv Card Electrophysiol. 2025 Feb 14. doi: 10.1007/s10840-025-02016-9.
Treatment of PAF with PVI is the gold standard approach. Recently, esophageal cooling has been shown to significantly reduce the risk of esophageal injury during thermal ablation. This study investigated outcomes of HPSD before and after instituting esophageal cooling.
In this natural experiment, we enrolled 346 consecutive patients with PAF undergoing initial ablation using HPSD, 143 patients immediately prior to and 203 patients immediately after switching from luminal esophageal monitoring (LET arm) to esophageal cooling with ensoETM (ensoETM arm). The primary endpoint was time-to-atrial arrhythmia recurrence.
The procedure times were significantly faster with ensoETM (82.9 ± 27 vs 112 ± 49 min, p < 0.0001). At a median follow-up of 10.3 ± 3.4 months, the atrial arrhythmia recurrence rate did not significantly differ between LET and ensoETM arms (25.2% vs 30.0%, p = 0.3202). Kaplan-Meier analysis showed no significant difference in the overall atrial arrhythmia recurrence (log-rank, p = 0.3780). Statistical analysis of all notable comorbidities revealed no significant association with procedural outcomes.
In patients with PAF undergoing an initial ablation procedure with HPSD, esophageal cooling led to significantly faster procedures, with no decrease in efficacy.
肺静脉隔离术（PVI）治疗阵发性房颤（PAF）是金标准方法。最近，食管冷却已被证明可显著降低热消融过程中食管损伤的风险。本研究调查了采用食管冷却前后高压选择性直流电消融（HPSD）的结果。
在这项自然实验中，我们连续纳入了346例接受HPSD首次消融的PAF患者，其中143例在从腔内食管监测（LET组）切换到ensoETM食管冷却之前，203例在切换之后。主要终点是房性心律失常复发时间。
ensoETM组的手术时间明显更快（82.9±27分钟对112±49分钟，p<0.0001）。在中位随访10.3±3.4个月时，LET组和ensoETM组的房性心律失常复发率无显著差异（25.2%对30.0%，p=0.3202）。Kaplan-Meier分析显示总体房性心律失常复发无显著差异（对数秩检验，p=0.3780）。对所有显著合并症的统计分析显示与手术结果无显著关联。
在接受HPSD首次消融手术的PAF患者中，食管冷却使手术速度明显加快，且疗效未降低。
