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Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.

https://arctichealth.org/en/permalink/ahliterature136981
Source
Circ Arrhythm Electrophysiol. 2011 Apr;4(2):149-56
Publication Type
Article
Interactive/Multimedia
Date
Apr-2011
Author
Luiz R Leite
Simone N Santos
Henrique Maia
Benhur D Henz
Fábio Giuseppin
Anderson Oliverira
André R Zanatta
Ayrton K Peres
Clarissa Novakoski
Jose R Barreto
Fabrício Vassalo
Andre d'Avila
Sheldon M Singh
Author Affiliation
Instituto Brasília de Arritmia, Brasilia, Brasil.
Source
Circ Arrhythm Electrophysiol. 2011 Apr;4(2):149-56
Date
Apr-2011
Language
English
Publication Type
Article
Interactive/Multimedia
Keywords
Adult
Aged
Atrial Fibrillation - surgery - ultrasonography
Body temperature
Burns - diagnosis - etiology - prevention & control
Catheter Ablation - adverse effects - instrumentation
Catheters
Chi-Square Distribution
Equipment Design
Esophageal Fistula - diagnosis - etiology - prevention & control
Esophagoscopy
Esophagus - injuries - physiopathology - ultrasonography
Female
Humans
Male
Middle Aged
Monitoring, Intraoperative - instrumentation - methods
Ontario
Pilot Projects
Predictive value of tests
Prospective Studies
Ulcer - diagnosis - etiology - prevention & control
Ultrasonography, Interventional - instrumentation
Abstract
Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation.
Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy.
A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.
PubMed ID
21325208 View in PubMed
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