Esophageal contraction during cryoablation: A possible protective mechanism

Cai, Dongsheng; Liu, Qiang; Shehata, Michael; Jiang, Ruhong; Lu, Yu; Zhang, Pei; Sun, Yaxun; Chen, Shiquan; Zhang, Zuwen; Fu, Guosheng; Jiang, Chenyang; Wang, Xunzhang

doi:10.1111/pace.13967

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…This result is consistent with ours 20 . Moreover, esophageal contraction can be observed during catheter ablation 21,22 . We speculate that this phenomenon may not occur sufficiently in the case of a middle‐sided esophagus.…”

Section: Discussionsupporting

confidence: 91%

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Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

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Background Catheter ablation for atrial fibrillation is an effective treatment; however, periesophageal vagal nerve injury is not rare and sometimes results in acute gastroparesis (AGP) after atrial fibrillation ablation (AFA). We sought to investigate the incidence and risk factors of AGP via preprocedural computed tomography (CT) analysis. Methods We retrospectively reviewed 422 patients who underwent index AFA at our center. Using contrast‐enhanced CT performed before ablation, the anatomical characteristics of the esophagus were compared between patients with and without post‐ablation AGP. AGP was diagnosed by the presence of symptoms, fasting abdominal X‐ray radiography as a screening test, and additional abdominal imaging. Results Of the 422 patients (age, 67 ± 11 years; male, 68.5%; cryoballoon, 63.7%), AGP developed in 14 (3.3%) patients, and six of 14 patients were asymptomatic. AGP resolved in all patients within 4 weeks without invasive treatment. In the AGP group, the esophagus was frequently located on the vertebra (middle‐positioned esophagus) (AGP vs non‐AGP, 42.9% vs 11.5%; P = .01), and additional posterior wall ablation was frequently performed (50.0% vs 14.5%; P = .02). In the multivariate analysis, middle‐positioned esophagus (P = .02; odds ratio, 9.0; 95% confidence interval [CI], 1.5‐53.3) and additional posterior wall ablation (P = .01; odds ratio, 7.6; 95% CI, 1.5‐42.1) were independent predictors of AGP. Conclusions Anatomical evaluation of the esophagus using CT may be simple and useful for predicting AGP after AFA. High‐risk patients who have middle‐positioned esophagus or who underwent excessive posterior wall ablation should be followed up closely.

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Section: Discussionsupporting

confidence: 91%

“… 20 Moreover, esophageal contraction can be observed during catheter ablation. 21 , 22 We speculate that this phenomenon may not occur sufficiently in the case of a middle‐sided esophagus. Nevertheless, further clinical studies using contrast esophagography during AFA are necessary to verify this hypothesis.…”

Section: Discussionmentioning

confidence: 89%

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Yakabe

Fukuyama

Araki

et al. 2021

Journal of Arrhythmia

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“…These authors also detected significant histological differences between the two modalities, including a higher incidence of partial- and full-thickness esophageal ulcerations with radiofrequency versus cryoablation. Furthermore, an interesting study by Cai et al 59 recently discovered a correlation between esophageal contraction and cryoenergy, suggesting perhaps that this phenomenon might in itself serve as a protective mechanism to the esophagus during cryoablation. But before recognizing the cryoballoon as a suitable tool for LAPW ablation, it is important to first review the rationale for this approach as well as the biophysics of cryoballoon ablation.…”

Section: Rationale For Cryoballoon Ablation Of the Left Atrial Posterior Wall And The Pulmonary Venous Componentmentioning

confidence: 99%

Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation

Aryana¹

2021

J Innov Cardiac Rhythm Manage.

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There is strong evidence in support of pulmonary vein isolation (PVI) with concomitant left atrial (LA) posterior wall (PW) isolation (PWI) for the treatment of patients with persistent atrial fibrillation (persAF). While this may be achieved using surgical and catheter-based strategies, there is growing interest in performing this approach using the cryoballoon. There are several potential advantages to this strategy. First, lesions created using the current-generation cryoballoons are typically large and durable. Second, cryoballoon ablation offers a simple technique to directly ablate and debulk the LAPW. Moreover, some consider cryoenergy a safer modality specifically with regard to collateral structures (ie, the esophagus). Based on the available data, cryoballoon PVI + PWI is associated with greater intraprocedural AF terminations and reductions in long-term AF recurrence (typically by ~20%), as compared to PVI alone in patients with persAF, but with similar rates of adverse events. As such, PVI + PWI has emerged as a significant predictor of freedom from recurrent AF (odds ratio: 3.67, 95% confidence interval: 1.44–9.34; p = 0.006) as well as all atrial arrhythmias (hazard ratio: 2.04, 95% confidence interval: 1.15–3.61; p = 0.015). Adjunct radiofrequency ablation to complete PWI is required in at least one-third of the patients, and this need is highly predicted by the LA size (significantly increased with an LA diameter > 48 mm). LAPW reconnection also seems to be associated with LA dimension, particularly an LA diameter greater than 48 mm (negative predictive value: 89.7%). Nevertheless, based on the analysis of patients who underwent repeat electrophysiology study for arrhythmia recurrences, cryoballoon PVI + PWI yields acceptable long-term durability (> 80%).

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Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

Erkapic,

Roussopoulos,

Aleksic

et al. 2024

Diagnostics

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Background: Atrial fibrillation (AF) ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial. Methods: This prospective study involved 100 consecutive AF patients undergoing cryoballoon ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months. Results: The cohort included 69% men, with a median age of 65.5 years. Post-ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B. Conclusion: Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.

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Esophageal contraction during cryoablation: A possible protective mechanism

Cited by 3 publications

References 6 publications

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Anatomical evaluation of the esophagus using computed tomography to predict acute gastroparesis following atrial fibrillation ablation

Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation

Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

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