Randomized Comparison Between Open Irrigation Technology and Intracardiac‐Echo‐Guided Energy Delivery for Pulmonary Vein Antrum Isolation: Procedural Parameters, Outcomes, and the Effect on Esophageal Injury

Marrouche, Nassir F.; Guenther, Jens; Segerson, Nathan M.; Daccarett, Marcos; Rittger, Harald; Marschang, Harald; Schibgilla, Volker; Schmidt, Martin; Ritscher, Guido; Noelker, Georg; Brachmann, Johannes

doi:10.1111/j.1540-8167.2007.00879.x

Cited by 76 publications

(95 citation statements)

References 37 publications

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“…6 In fact, development of esophageal ulcerations has been found to be dependent on the RFCA lesion set as well as the maximum energy delivered at the posterior left atrial wall. 7 Also, some authors believe that esophageal ulceration can be a potential precursor of a dramatic life-threatening condition, the atrio-esophageal fistula.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited “Jackhammer Esophagus”: A New Complication Due to Vagal Nerve Stimulation?

Tolone

Savarino

Docimo

2015

J Neurogastroenterol Motil

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Radiofrequency catheter ablation (RFCA) is a potentially curative method for treatment of highly symptomatic and drug-refractory atrial fibrillation (AF). However, this technique can provoke esophageal and nerve lesion, due to thermal injury. To our knowledge, there have been no reported cases of a newly described motor disorder, the Jackhammer esophagus (JE) after RFCA, independently of GERD. We report a case of JE diagnosed by high-resolution manometry (HRM), in whom esophageal symptoms developed 2 weeks after RFCA, in absence of objective evidence of GERD. A 65-year-old male with highly symptomatic, drug-refractory paroxysmal AF was candidate to complete electrical pulmonary vein isolation with RFCA. Prior the procedure, the patient underwent HRM and impedance-pH to rule out GERD or hiatal hernia presence. All HRM parameters, according to Chicago classification, were within normal limits. No significant gastroesophageal reflux was documented at impedance pH monitoring. Patient underwent RFCA with electrical disconnection of pulmonary vein. After two weeks, patient started to complain of dysphagia for solids, with acute chest-pain. The patient repeated HRM and impedance-pH monitoring 8 weeks after RFCA. HRM showed in all liquid swallows the typical spastic hypercontractile contractions consistent with the diagnosis of JE, whereas impedance-pH monitoring resulted again negative for GERD. Esophageal dysmotility can represent a possible complication of RFCA for AF, probably due to a vagal nerve injury, and dysphagia appearance after this procedure must be timely investigated by HRM.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited “Jackhammer Esophagus”: A New Complication Due to Vagal Nerve Stimulation?

Tolone

Savarino

Docimo

2015

J Neurogastroenterol Motil

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“…insertion depth of the electrode into the tissue) [Tungjitkusolmun et al 2001], and blood flow on electrode and cardiac surface [Cao et al 2001]. The effect of different electrode designs [Marrouche et al 2007] or even different energy sources [Aupperle et al 2005] could also be considered.…”

Section: )mentioning

confidence: 99%

“…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]. …”

Section: Introductionmentioning

confidence: 99%

“…Much current research is focused on finding a way to minimize thermal injury in the esophagus during radiofrequency (RF) catheter ablation of the left atrium [Aupperle et al 2005, Marrouche et al 2007, Ren et al 2006, Sherzer et al 2007. In a previous report [Berjano et al 2005a], we proposed a device to minimize esophageal damage during RF ablation, which consisted of a balloon with internal cooling situated in the esophageal lumen next to the atrial lesion.…”

Section: Introductionmentioning

confidence: 99%

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

Lequerica¹,

Berjano²,

Herrero³

et al. 2008

Phys. Med. Biol.

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Lequerica, JL.; Berjano, E.; Herrero, M.; Melecio, L.; Hornero, F. (2008). Cooled waterirrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: Experimental study based on an agar phantom. Physics in AbstractA great deal of current research is directed to finding a way to minimize thermal injury in the esophagus during radiofrequency (RF) catheter ablation of the atrium. A recent clinical study employing a cooling intraesophageal balloon reported a reduction of the temperature in the esophageal lumen. However, it could not be determined whether the deeper muscular layer of the esophagus was cooled enough to prevent injury. We built a model based on an agar phantom in order to experimentally study the thermal behavior of this balloon by measuring the temperature not only on the balloon, but also at a hypothetical point between the esophageal lumen and myocardium (2 mm distant).Controlled temperature (55ºC) ablations were conducted for 120 s. The results showed that: 1) The cooling balloon provides a reduction in the final temperature reached, both on the balloon surface and at a distance of 2 mm; 2) Coolant temperature has a significant effect on the temperature measured at 2 mm from the esophageal lumen (it has less effect on the temperature measured on the balloon surface); and 3) The precooling period has a significant effect on the temperature measured on the balloon surface (the effect on the temperature measured 2 mm away is small). The results were in good agreement with those obtained in a previous clinical study. The study suggests that that the cooling balloon gives thermal protection to the esophagus when a minimum pre-cooling period of 2 minutes is programmed at a coolant temperature of 5ºC or less.

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“…Endoscopy (and TEE) should be avoided as instrumentation of the esophagus may cause rapid deterioration and even death, as noted in previous surgical cases (26,27). Sensitivity of a barium swallow is low for detection of fistulas therefore the best (34,35), introduction of open irrigated systems for ablation (28), esophageal cooling with water-irrigated intraesophageal balloon during the ablation (36), using pain as an indicator of temperature rise in the esophagus (37).…”

Section: Atrioesophageal Fistula As a Complication Of Ablation Proceduresmentioning

confidence: 99%

New aspects of ablation treatment for atrial fibrillation

Bencsik¹

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Randomized Comparison Between Open Irrigation Technology and Intracardiac‐Echo‐Guided Energy Delivery for Pulmonary Vein Antrum Isolation: Procedural Parameters, Outcomes, and the Effect on Esophageal Injury

Abstract: Although both OIT and ICE-guided energy delivery possess a similar effect in treating AF, OIT seems to be superior in terms of achieving isolation and shortening fluoroscopy exposure. Moreover, a lower incidence of esophageal wall injury was observed utilizing OIT for PVAI.

Cited by 76 publications

References 37 publications

Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited “Jackhammer Esophagus”: A New Complication Due to Vagal Nerve Stimulation?

Radiofrequency Catheter Ablation for Atrial Fibrillation Elicited “Jackhammer Esophagus”: A New Complication Due to Vagal Nerve Stimulation?

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

New aspects of ablation treatment for atrial fibrillation

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