Shorter distance between the esophagus and the left atrium is associated with higher rates of esophageal thermal injury after radiofrequency ablation

Ishidoya, Yuki; Kwan, Eugene; Dosdall, Derek J.; MacLeod, Rob S.; Navaravong, Leenhapong; Steinberg, Benjamin A.; Bunch, T. Jared; Ranjan, Ravi

doi:10.1111/jce.15554

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…However, epicardial fat distribution is poorly correlated with the patients obesity 23 —as such, obesity might not be protective considering thermal injury formation. Therefore, preprocedural esophageal imaging using MRI or intraprocedural esophageal imaging using intracardiac ultrasound might be implemented to reduce EDEL occurence 25,26 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, preprocedural esophageal imaging using MRI or intraprocedural esophageal imaging using intracardiac ultrasound might be implemented to reduce EDEL occurence. 25,26 Preexisting GERD was shown to be associated with thermal injury formation in a "double hit" theory of esophageal damage in a study with 95 patients undergoing cryo-balloon PVI. 27 This could not be confirmed in our cohort undergoing RF ablation.…”

Section: Yarlagadda Et Al Performed a Meta-analysis Of Edel Reportedmentioning

confidence: 99%

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Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Francke¹,

Naumann²,

Weidauer³

et al. 2022

Cardiovasc electrophysiol

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Introduction: Pulmonary vein isolation (PVI) using high-power-short-duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short-term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach.Methods: In a single-center experience, 388 consecutive standardized first-time AF ablation were performed using a CLOSE-guided-fixed-50 W-circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis.Results: EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low-grade Kansas-city-classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p < .001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 s, p < .001), while achieved ablation index was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). Conclusion:Incidence of EDEL after CLOSE-guided-50 W-HPSD PVI is lower compared to historical cohorts using standard-power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 g.

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Section: Discussionmentioning

confidence: 99%

Section: Yarlagadda Et Al Performed a Meta-analysis Of Edel Reportedmentioning

confidence: 99%

Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Francke¹,

Naumann²,

Weidauer³

et al. 2022

Cardiovasc electrophysiol

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“…It was further validated by the integrated model in ROC containing multiple parameters which showed the best predictive ability for AEPVR. The relative inadequate energy applied at the posterior wall could be explained by the inevitable concerns of complication, for example, esophageal damage, gastric immobility, and cardiac tamponade 22,23 …”

Section: Discussionmentioning

confidence: 99%

“…The relative inadequate energy applied at the posterior wall could be explained by the inevitable concerns of complication, for example, esophageal damage, gastric immobility, and cardiac tamponade. 22,23 Another mechanism was the delayed manifestation of ICB connection between the right anterior carina and the right atrium, which also commonly present in the repeat procedures (Supporting Information S2: Figure S2). During circumferential ablation at the anterior wall of the right PVs, conduction of ICB can be occasionally blocked when RF is applied close to the carina.…”

Section: Characteristics and Possible Mechanisms Of Aepvrmentioning

confidence: 99%

Acute epicardial pulmonary vein reconnection: Nondurable transmural lesion or late manifestation of conduction through intercaval bundle

Gu,

Liu,

et al. 2024

Cardiovasc electrophysiol

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IntroductionAcute pulmonary vein reconnection (PVR) via epicardial fibers can be found during observation period after PV isolation, the characteristics and related factors have not been fully studied. We aimed to investigate the prevalence, locations, electrogram characteristics, and ablation parameters related to acute epicardial pulmonary vein reconnection (AEPVR).MethodsAcute PVR was monitored during observation period after PV isolation. AEPVRs were mapped and distinguished from endocardial conduction gaps. The clinical, electrophysiological characteristics and lesion set parameters were compared between patients with and without PVR. They were also compared among AEPVR, gap‐related reconnection, and epicardial PVR in repeat procedures.ResultsA total of 56.1% acute PVR were AEPVR, which required a longer waiting period (p < .001) than endocardial gap. The majority of AEPVR were connections from the posterior PV carina to the left atrial posterior wall, followed by late manifestation of intercaval bundle conduction from the right anterior carina to right atrium. AEPVR was similar to epicardial PVR in redo procedures in distribution and electrogram characteristics. Smaller atrium (p < .001), lower impedance drop (p = .039), and ablation index (p = .028) on the posterior wall were independently associated with presence of AEPVR, while lower interlesion distance (p = .043) was the only predictor for AEPVR in acute PVR. An integrated model containing multiple lesion set parameters had the highest predictive ability for AEPVR in receiver operating characteristics analysis.ConclusionsEpicardial reconduction accounted for the majority of acute PVR. AEPVR was associated with anatomic characteristics and multiple ablation‐related parameters, which could be explained by nondurable transmural lesion or late manifestation of conduction through intercaval bundle.

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“…It was further validated by the integrated model in ROC containing multiple parameters which showed the best predictive ability for AEPVR. The relative inadequate energy applied at the posterior wall could be explained by the inevitable concerns of complication e.g., esophageal damage, gastric immobility, and cardiac tamponade [21,22] (Figure 4A).…”

Section: Characteristics and Possible Mechanisms Of Aepvrmentioning

confidence: 99%

Acute Epicardial Pulmonary Vein Reconnection: Nondurable Transmural Lesion or Late Manifestation of Non-preferential Conduction

Xiong,

Gu,

Liu

et al. 2023

Preprint

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Background Acute pulmonary vein reconnection via epicardial fibers can be found during observation period after PV isolation, the characteristics and related factors have not been fully studied. Objective To investigate the prevalence, locations, electrogram characteristics and ablation parameters related to acute epicardial pulmonary vein reconnection (AEPVR). Methods Acute PVR was monitored during observation period after PV isolation, from which AEPVRs were mapped and distinguished from endocardial conduction gaps. The clinical, electrophysiological characteristics and lesion set parameters were compared between patients with and without PVR. So were they compared among AEPVR, gap-related reconnection, and epicardial PVR in repeat procedures. Results 56.1% acute PVR were AEPVR, which required a longer waiting period ( P<0.001) than endocardial gap. The majority of AEPVR were connections from the posterior PV antrum to the left atrial posterior wall, followed by late manifestation of intercaval bundle conduction from the right anterior carina to right atrium. AEPVR was similar to epicardial PVR in redo procedures in distribution and electrogram characteristics. Smaller atrium ( P<0.001), lower impedance drop ( P=0.039) and ablation index ( P=0.028) on the posterior wall were independently associated with presence of AEPVR, while lower inter-lesion distance ( P=0.043) was the only predictor for AEPVR in acute PVR. An integrated model containing multiple lesion set parameters had the highest predictive ability for AEPVR in ROC analysis. Conclusions Epicardial reconduction accounted for the majority of acute PVR. AEPVR was associated with anatomic characteristics and multiple ablation-related parameters, which could be explained by nondurable transmural lesion or late manifestation of non-preferential conduction.

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Shorter distance between the esophagus and the left atrium is associated with higher rates of esophageal thermal injury after radiofrequency ablation

Cited by 5 publications

References 13 publications

Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Acute epicardial pulmonary vein reconnection: Nondurable transmural lesion or late manifestation of conduction through intercaval bundle

Acute Epicardial Pulmonary Vein Reconnection: Nondurable Transmural Lesion or Late Manifestation of Non-preferential Conduction

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