Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions

BioMedical Engineering OnLine

Marcela Mercado¹  Shailee Shah²  Erik Kulstad³  Lisa Leung⁴  Mark Gallagher⁴ 

[1]Bioengineering Department, Engineering Faculty, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellin, Colombia

[2]Illinois Institute of Technology, Chicago, USA

[3]Southwestern Medical Center, University of Texas, Dallas, TX, USA

[4]St. George’s University Hospitals NHS Foundation Trust, St. George’s, University of London, Cranmer Terrace, Tooting, SW17 0RE, London, UK

关键词: Atrial fibrillation;    Radiofrequency ablation;    Esophageal protection;    Finite element model;    Mathematical modeling;    Esophageal cooling;    Ablation parameters;   

DOI  :  10.1186/s12938-020-00821-z

来源: Springer

【 摘 要 】

BackgroundEsophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. Existing methods to prevent esophageal injury have various limitations in deployment and uncertainty in efficacy. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. We sought to develop a mathematical model of this process to guide further studies and clinical investigations and compare results to real-world clinical data.ResultsThe model predicts that the esophageal coolingdevice, even with body-temperature water flow (37 °C) provides a reduction in esophageal thermal injury compared to the case of the non-protected esophagus, with a non-linear direct relationship between lesion depth and the cooling water temperature. Ablation power and cooling water temperature have a significant influence on the peak temperature and the esophageal lesion depth, but even at high RF power up to 50 W, over durations up to 20 s, the cooling device can reduce thermal impact on the esophagus. The model concurs with recent clinical data showing an 83% reduction in transmural thermal injury when using typical operating parameters.ConclusionsAn esophageal cooling device appears effective for esophageal protection during atrial fibrillation, with model output supporting clinical data. Analysis of the impact of ablation power and heart wall dimensions suggests that cooling water temperature can be adjusted for specific ablation parameters to assure the desired myocardial tissue ablation while keeping the esophagus protected.

【 授权许可】

CC BY