Esophageal Deviation During Atrial Fibrillation Ablation

Bhardwaj, Rahul; Naniwadekar, Aditi; Whang, William; Mittnacht, Alexander J.C.; Palaniswamy, Chandrasekar; Koruth, Jacob S.; Joshi, Kamal; Sofi, Aamir; Miller, Marc A.; Choudry, Subbarao; Dukkipati, Srinivas R.; Reddy, Vivek Y.

doi:10.1016/j.jacep.2018.04.001

Cited by 51 publications

(31 citation statements)

References 15 publications

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“…The most common method involves manipulation of the trans-esophageal echo probe to deviate the esophagus 15 . Dedicated devices have also been studied Balloon Retractor 16 . These methods are imperfect and potentially harmful.…”

Section: Discussionmentioning

confidence: 99%

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Improving esophageal protection during AF ablation: The IMPACT study

Leung

Bajpai

Zuberi

et al. 2020

Preprint

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Background: Thermal injury to the esophagus is a known complication of ablation for atrial fibrillation (AF) and accounts for most procedure-related mortality. Thermal protection of the esophageal lumen by infusing cold liquid can reduce thermal injury to a limited extent. Objective: To investigate the ability of a powerful temperature control device to protect the esophagus from ablation-related thermal injury. Methods: A single-center, prospective, double-blinded randomized controlled trial was used to investigate the ability of the ensoETM device to protect the esophagus from thermal injury. This method was compared in a 1:1 randomization to a control group of standard practice utilizing a single-point temperature probe. In the study group, the device was used to keep the luminal temperature at 4 degrees during radiofrequency (RF) ablation for AF. Endoscopic examination was performed at 7 days post-ablation and esophageal injury was scored. The patient and the endoscopist were blinded to the randomization. Results: We recruited 188 patients, of whom 120 underwent endoscopy. Thermal injury to the mucosa was significantly more common in the control group than in those receiving esophageal protection (12/60 versus 2/60; P=0.008), with a trend toward reduction in gastroparesis (6/60 Vs 2/60, p=0.27). There was no difference between groups in RF duration, force, power and combined ablation index (P value range= 0.2-0.9). Procedure duration and fluoroscopy duration were similar (P=0.97, P=0.91 respectively). Conclusion: Thermal protection of the esophageal lumen significantly reduces ablation-related thermal injury compared to standard care. This method of esophageal protection is safe and does not compromise the efficacy of the ablation procedure.

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Section: Discussionmentioning

confidence: 99%

“…The copyright holder for this preprint this version posted February 4, 2020. . https://doi.org/10.1101/2020.01.30.20019158 doi: medRxiv preprint also been studied Balloon Retractor 16 . These methods are imperfect and potentially harmful.…”

Section: Preventing Atrio-esophageal Fistulamentioning

confidence: 99%

Improving esophageal protection during AF ablation: The IMPACT study

Leung

Bajpai

Zuberi

et al. 2020

Preprint

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“…This technique, however, has not been widely embraced since results are variable. Another reported technique to deviate the esophagus is balloon deviation (DV8; Manual Surgical Sciences), 26 which is a polyurethane device wrapped in silicone. As the device is inflated, the preshaped balloons result in increased esophageal pressure to a mean of 5 atmospheres (73 pounds per square inch, psi) and a maximum of 16 atmospheres (235 psi).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a novel esophageal retractor utilizing vacuum suction and mechanical force for deviating the esophagus

Houmsse

Daoud

Joseph

et al. 2020

Cardiovasc electrophysiol

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Background Deviation of the esophagus prevents esophageal injury during atrial fibrillation ablation. Objectives This study is to evaluate, in animals, safety and effectiveness of a novel esophageal retractor that utilizes vacuum suction and mechanical force to deviate the esophagus. Methods Following general anesthesia, a radiopaque ruler was placed behind the animal perpendicular to the esophagus. The esophageal retractor was inserted and esophagram was completed. Suction force (280‐300 mm Hg) was applied to the distal aspect of the device that resulted in adherence of the esophagus in a circumferential manner. Then movement of a deflecting arm was used to deviate the esophagus. Four animal studies completed: (a) deviation distance and presence of trailing edge; (b) effect of 1 hour continuous suction and deviation upon esophageal cellular architecture; (c) impact on luminal esophageal temperature (LET) during high power ablation; and (d) compatibility of esophageal retractor with electroanatomic mapping system. Results The distance of deviation to the right (26.6 ± 2.5 mm) was higher than to the left (18.7 ± 2.3 mm; P < .01). There was no esophageal trailing edge in 65/68 deviations (96%). With continuous suction for 1 hour, pathology revealed small, <1mm, circular area of hyperemia in the esophageal mucosa. During high power ablation, the maximum increase in LET was 0.2°C. Finally, there was no interference between the device and electro‐anatomical mapping system. Conclusion In animal models, the esophageal retractor utilizing vacuum suction was successful at deviating the esophagus without significant trailing edge and with minor (1 mm) injury with prolonged continuous suction.

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“…Another reported technique to deviate the esophagus is balloon deviation using the DV8 device 34 , which is a polyurethane device wrapped in silicone (Manual Surgical Sciences). Although the device is commercially available, it is not FDA approved.…”

Section: -Balloon Deviationmentioning

confidence: 99%

Protection of the Esophagus During Catheter Ablation of Atrial Fibrillation

Houmsse

Daoud

2020

Preprint

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Esophageal injury still occurs with high frequency during ablation of atrial fibrillation (AF). The purpose of this study is to provide a review of methods to protect the esophagus from injury during AF ablation. Despite advances in imaging and ablation, the potential risk of esophageal injury during AF ablation remains an important concern with a high occurrence of esophageal injury (≈15%). There have been numerous studies evaluating varied techniques for esophageal protection including active cooling and displacement of the esophagus. These techniques are reviewed in this manuscript as well as the role of esophageal protection in managing patients undergoing AF ablation procedure.

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Esophageal Deviation During Atrial Fibrillation Ablation

Abstract: MED with the balloon retractor safely moved the esophagus away from the site of energy delivery during atrial fibrillation ablation.

Cited by 51 publications

References 15 publications

Improving esophageal protection during AF ablation: The IMPACT study

Improving esophageal protection during AF ablation: The IMPACT study

Evaluation of a novel esophageal retractor utilizing vacuum suction and mechanical force for deviating the esophagus

Protection of the Esophagus During Catheter Ablation of Atrial Fibrillation

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