Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions

BMC Cardiovascular Disorders

Research Article

Reiner Füth¹  Mark Lankisch¹  Osman Tutdibi¹  Wilfried Dinh¹  Micheal Müller¹  Karsten Pomsel¹  Armin Sause¹  Jan Janssen²  Thomas Glosemeyer-Allhoff³ 

[1] HELIOS Klinikum Wuppertal, Department of Cardiology, Arrenberger Str. 20, 42117, Wuppertal, Germany;University Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany;HELIOS Klinikum Wuppertal, Department of Gastroenterology, Heusenerstr. 40, 42283, Wuppertal, Germany;University Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany;St. Martinus-Hospital, Department of Gastroenterology, Hospitalweg 6, 57462, Olpe, Germany;

关键词: Pulmonary Vein;    Left Atrium;    Radiofrequency Ablation;    Pulmonary Vein Isolation;    Pulmonary Vein Stenosis;   

DOI  :  10.1186/1471-2261-10-52

 received in 2010-06-10, accepted in 2010-10-26,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundAtrio-esophageal fistula formation following radiofrequency ablation of left atrial tachyarrhythmias is a rare but devastating complication. Esophageal injuries are believed to be precursors of fistula formation and reported to occur in up to 47% of patients. This study investigates the incidence of esophageal lesions when real time esophageal temperature monitoring and temperature limitation is used.Methods184 consecutive patients underwent open irrigated radiofrequency ablation of left atrial tachyarrhythmias. An esophageal temperature probe consisting of three independent thermocouples was used for temperature monitoring. A temperature limit of 40°C was defined to interrupt energy delivery. All patients underwent esophageal endoscopy the next day.ResultsEndoscopy revealed ulcer formation in 3/184 patients (1.6%). No patient developed atrio-esophageal fistula. Patient and disease characteristics had no influence on ulcer formation. The temperature threshold of 40°C was reached in 157/184 patients. A temperature overshoot after cessation of energy delivery was observed frequently. The mean maximal temperature was 40.8°C. Using a multiple regression analysis creating a box lesion that implies superior- and inferior lines at the posterior wall connecting the right and left encircling was an independent predictor of temperature. Six month follow-up showed an overall success rate of 78% documented as sinus rhythm in seven-day holter ECG.ConclusionLimitation of esophageal temperature to 40°C is associated with the lowest incidence of esophageal lesion formation published so far. This approach may contribute to increase the safety profile of radiofrequency ablation in the left atrium.

【 授权许可】

CC BY   
© Sause et al; licensee BioMed Central Ltd. 2010