Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Singh, Sheldon M.; d’Ávila, André; Doshi, Shephal K.; Brugge, William R.; Bedford, Rudolph A.; Mela, Theofanie; Ruskin, Jeremy N.; Reddy, Vivek Y.

doi:10.1161/circep.107.789552

Cited by 83 publications

(35 citation statements)

References 23 publications

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“…27 It should also be noted that some of UGI dysfunction can be because of direct injury to the intrinsic (myentric) plexi of the esophagus without affecting the VN, through the similar pathological mechanisms. 28 In a recent study by Singh et al, 29 there was no correlation between LET and esophageal ulcerations or ablation energy and LET. Our findings were consistent with their study, and we did not find any association between LET and VN injury.…”

Section: Discussionmentioning

confidence: 91%

“…Monitoring of LET, periprocedural imaging with computed tomography, MRI or intracardiac echocardiography, modulation of power and duration of radiofrequency energy during ablation and mechanical esophageal displacement have been suggested as possible ways to decrease injury to the esophagus. [29][30][31][32][33][34][35][36][37] However, their roles in preventing VN injury during RFA have not been systematically studied. Further studies are therefore necessary to identify methods to safely perform AF ablation without damaging the VN.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated. Methods and Results-We performed a prospective, observational study assessing the effect of atrial fibrillation ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study, and sham-feeding test (corresponding to esophageal, gastric, and small intestinal function evaluation, respectively) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 new abnormality on the UGI function tests (P<0.001). New onset esophageal dysmotility, delayed gastric emptying time, and abnormal sham-feeding tests were observed in 13 (48%), 13 (48%), and 9 (33%) patients, respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (P=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions-Atrial fibrillation ablation results in functional impairment of the UGI system, including the esophagus, stomach, and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Direct monitoring of intraluminal temperature with thermocouple esophageal probe during procedure provides an opportunity to adjust RF energy at ablation on posterior wall of the LA and reduces incidence of esophageal mucosal lesion from 36% to 6% [181]. Limiting the RF energy on the LA posterior wall at 25-30 W also significantly reduced occurrence of esophageal mucosal lesions [176].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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“…With a total EU appearance of 2.2% in the whole patient cohort, we report a much lower event rate than in most other studies published (4% to 48%) (28,58,61,62). Studies consistently screening for EU were small in sample size and reported a total of 11% and 26% of esophageal injuries, respectively (58,61).…”

Section: Identification Of a High-risk Population For Esophageal Injucontrasting

confidence: 59%

“…In our study, we again demonstrate a low incidence of EU using an OIC technique, confirming previous results of a randomized prospective trial. Temperature probes were used to monitor energy delivery and temperature increase in the esophagus in other studies (28,31,58,63,65). As stated in these studies, luminal esophageal temperature (LET) monitoring has major limitations, such as malalignment of the probe to the RFA catheter and posterior LA wall, the underestimation of intramural temperature by an intraluminal probe, and the too-slow LET increase to prevent EU.…”

Section: Identification Of a High-risk Population For Esophageal Injumentioning

confidence: 99%

New aspects of ablation treatment for atrial fibrillation

Bencsik¹

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Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Cited by 83 publications

References 23 publications

Effect of Atrial Fibrillation Ablation on Gastric Motility

Effect of Atrial Fibrillation Ablation on Gastric Motility

Catheter Ablation of Lone Atrial Fibrillation

New aspects of ablation treatment for atrial fibrillation

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