Ablation of atrial fibrillation and esophageal injury: Effects of energy source and ablation technique

Abstract

Esophageal alterations were found in numerous cases. However, marked lesions were especially induced by endocardial unipolar radiofrequency and cryoablation.

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

“…8 -10 Currently, the most commonly used clinical strategy to minimize esophageal thermal injury during AF ablation involves limiting the magnitude of power (25 to 35 W), as well as the duration (Ͻ30 s), of RF applications placed along the posterior wall of the LA. [11][12][13] A major limitation of this approach is that it fails to account for the variability in the thickness of the posterior LA wall and the presence of periesophageal connective tissue-important determinants of esophageal heating. 7,14,15 Thus, empirically limiting the power and duration of RF applications may be insufficient to prevent esophageal thermal injury in all patients.…”

“…[11][12][13] It has been suggested that the muscular layer of the esophagus absorbs most of the heat and is most susceptible to injury. 8,12 Injury to this area may result in reduced esophageal elasticity producing symptoms of dysphagia. 4 Aupperle et al 12 systematically evaluated esophageal injury in sheep undergoing AF ablation.…”

An Analytical Solution for a Bio-heat Transfer Problem

“…The cross-sectioned fatty pad is assumed 1 mm thick [21]. Additionally, the mean thickness of the posterior LA wall ranges from 1.9 to 4.0 mm, and the mean thickness of the esophageal wall (from mucosa to adventitia) adjacent to the LA ranges from 1.5 to 4.5 mm [2,11,30]. In the presence of these factors, we take average values for the physiological parameters in Table 1.…”

“…The patients that are good candidates for one catheter-based ablation technique may not be for other type to have a chance at having their problem cured. Indeed, various energy sources have been used as the radiofrequency energy, the microwave, the laser, the cryothermia, and the high-intensity focused ultrasound [2,13]. However, all procedures have one common involved risk: that of damage to nearby healthy tissue.…”

A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

“…This question is essential, since two recent experimental studies demonstrated severe cases of thermal injury in the esophagus muscular layer during RF cardiac ablation [Aupperle et al 2005, Marrouche et al 2007]. …”