Grosse Meininghaus Dirk, Freund Robert, Kulstad Erik, Geller J Christoph
Division of Cardiology, Medical University Lausitz-Carl Thiem, Cottbus, Germany.
Thiem Research, Medical University Lausitz-Carl Thiem, Cottbus, Germany.
Heart Rhythm O2. 2025 May 22;6(8):1106-1113. doi: 10.1016/j.hroo.2025.05.019. eCollection 2025 Aug.
Damage to peri-esophageal tissue may occur following pulmonary vein isolation (PVI). Active esophageal cooling has been shown to reduce the incidence of mucosal esophageal injury, probably by dissipation of heat and inhibition of inflammation. Whether it also protects the peri-esophageal vagal nerve plexus and reduces gastric hypomotility and food retention is uncertain.
The study aimed to analyze and compare the incidence of esophageal and vagal nerve injury following radiofrequency-current (RF) PVI with active esophageal cooling to that of luminal esophageal temperature (LET) monitoring.
Using endoscopy and electrogastrography, esophageal and peri-esophageal injury (mucosal lesions, food retention, and vagal nerve injury) were prospectively assessed following RF-PVI with active esophageal cooling and compared with RF-PVI with LET monitoring.
A total of 64 patients (69 [65/75] years, 58% men) undergoing RF-PVI for atrial fibrillation with esophageal cooling under (deep) conscious sedation were prospectively studied and compared with 52 LET-monitored patients.Following RF-PVI with active cooling, 4.7% had mucosal erythema, 15.6% new-onset food retention, and 14.1% ablation-induced vagal nerve injury. In comparison, the LET-monitored cohort showed 11.5% with mucosal esophageal lesions, 26.9% new-onset food retention, and 28.8% ablation-induced vagal nerve injury. The rate of any esophageal injury per patient was decreased by a factor of 0.51 ([95% confidence interval 0.30, 0.86]; .0142).
In RF-PVI, active esophageal cooling reduces ablation-induced vagal nerve injury and overall peri-esophageal injury.
肺静脉隔离（PVI）后可能会发生食管周围组织损伤。主动食管降温已被证明可降低食管黏膜损伤的发生率，这可能是通过散热和抑制炎症实现的。它是否还能保护食管周围迷走神经丛并减少胃动力不足和食物潴留尚不确定。
本研究旨在分析和比较射频电流（RF）PVI联合主动食管降温与食管腔内温度（LET）监测时食管和迷走神经损伤的发生率。
采用内镜检查和胃电图，对RF-PVI联合主动食管降温后的食管和食管周围损伤（黏膜病变、食物潴留和迷走神经损伤）进行前瞻性评估，并与LET监测的RF-PVI进行比较。
对64例（年龄69[65/75]岁，58%为男性）在（深度）清醒镇静下接受RF-PVI联合食管降温治疗房颤的患者进行前瞻性研究，并与52例LET监测的患者进行比较。主动降温的RF-PVI后，4.7%出现黏膜红斑，15.6%出现新发食物潴留，14.1%出现消融引起的迷走神经损伤。相比之下，LET监测组显示11.5%有食管黏膜病变，26.9%有新发食物潴留，28.8%有消融引起的迷走神经损伤。每位患者任何食管损伤的发生率降低了0.51倍（[95%置信区间0.30，0.86]；P = 0.0142）。
在RF-PVI中，主动食管降温可减少消融引起的迷走神经损伤和总体食管周围损伤。
