Circulation. Arrhythmia and electrophysiology · 2013
Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon.
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Metzner Andreas, Burchard Andre, Wohlmuth Peter, Rausch Peter, Bardyszewski Alexander, Gienapp Christina, Tilz Roland Richard, Rillig Andreas, Mathew Shibu, Deiss Sebastian, Makimoto Hisaki, Ouyang Feifan, Kuck Karl-Heinz, Wissner Erik
Аннотация
BACKGROUND: Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.
METHODS AND RESULTS: In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy.
CONCLUSIONS: Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.
METHODS AND RESULTS: In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy.
CONCLUSIONS: Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.