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Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water-Irrigated Intraesophageal Balloon: A Pilot Study
Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method usin...
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| Published in: | Journal of cardiovascular electrophysiology 2007-02, Vol.18 (2), p.145-150 |
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| container_end_page | 150 |
| container_issue | 2 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | TSUCHIYA, TAKESHI ASHIKAGA, KEIICHI NAKAGAWA, SUSUMU HAYASHIDA, KIYOSHI KUGIMIYA, HIROSHI |
| description | Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water‐irrigated intraesophageal balloon (IB).
Methods and Results: Eight patients with drug‐refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9‐Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P |
| doi_str_mv | 10.1111/j.1540-8167.2006.00693.x |
| format | article |
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Methods and Results: Eight patients with drug‐refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9‐Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow‐up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.
Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/j.1540-8167.2006.00693.x</identifier><identifier>PMID: 17239114</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>atrial fibrillation ; Atrial Fibrillation - therapy ; Body Temperature ; Catheter Ablation - instrumentation ; Catheter Ablation - methods ; Catheterization - instrumentation ; Catheterization - methods ; Equipment Design ; esophageal cooling ; Esophagus - physiology ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic - methods ; Pilot Projects ; radiofrequency catheter ablation ; Therapeutic Irrigation - methods ; Treatment Outcome ; Water</subject><ispartof>Journal of cardiovascular electrophysiology, 2007-02, Vol.18 (2), p.145-150</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4043-5c6691fbf53059c28575b976e515e527bef1f86037c9cfa1b4a0f007f885553d3</citedby><cites>FETCH-LOGICAL-c4043-5c6691fbf53059c28575b976e515e527bef1f86037c9cfa1b4a0f007f885553d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8167.2006.00693.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8167.2006.00693.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17239114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>TSUCHIYA, TAKESHI</creatorcontrib><creatorcontrib>ASHIKAGA, KEIICHI</creatorcontrib><creatorcontrib>NAKAGAWA, SUSUMU</creatorcontrib><creatorcontrib>HAYASHIDA, KIYOSHI</creatorcontrib><creatorcontrib>KUGIMIYA, HIROSHI</creatorcontrib><title>Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water-Irrigated Intraesophageal Balloon: A Pilot Study</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water‐irrigated intraesophageal balloon (IB).
Methods and Results: Eight patients with drug‐refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9‐Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow‐up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.
Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.</description><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - therapy</subject><subject>Body Temperature</subject><subject>Catheter Ablation - instrumentation</subject><subject>Catheter Ablation - methods</subject><subject>Catheterization - instrumentation</subject><subject>Catheterization - methods</subject><subject>Equipment Design</subject><subject>esophageal cooling</subject><subject>Esophagus - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic - methods</subject><subject>Pilot Projects</subject><subject>radiofrequency catheter ablation</subject><subject>Therapeutic Irrigation - methods</subject><subject>Treatment Outcome</subject><subject>Water</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNqNkFFv2yAUhVHVqe26_YWKp73ZA2PArvqSemmXquoibVOlviBsQ0pGTAZETf79SB21r0NCHOCce3U_ACBGOU7r6zLHtERZhRnPC4RYnnZN8u0ROHv7OE4alTQjFSen4GMIS4QwYYiegFPMC1JjXJ6B3SR6Iy28Ma031spo3AAn7UG8mPgMp8Gtn-VCJVfjnDXDYnyXr1fVw0cZlc9m3ptFUj2cDdFL9Z66ltY6N1zCCZwb6yL8GTf97hP4oKUN6vPhPAe_b6a_mu_Z_Y_bWTO5z7oSlSSjHWM11q2mBNG6KyrKaVtzpiimiha8VRrriiHCu7rTErelRBohrquKUkp6cg6-jHXX3v3dqBDFyoROpVkH5TZBsBqRgtU8GavR2HkXgldarL1ZSb8TGIk9drEUe7piT1fssYtX7GKboheHHpt2pfr34IFzMlyNhhdj1e6_C4u7ZppEimdj3ISotm9x6f8Ixgmn4vHhVswfnvDdt6YUc_IPhw2gKA</recordid><startdate>200702</startdate><enddate>200702</enddate><creator>TSUCHIYA, TAKESHI</creator><creator>ASHIKAGA, KEIICHI</creator><creator>NAKAGAWA, SUSUMU</creator><creator>HAYASHIDA, KIYOSHI</creator><creator>KUGIMIYA, HIROSHI</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200702</creationdate><title>Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water-Irrigated Intraesophageal Balloon: A Pilot Study</title><author>TSUCHIYA, TAKESHI ; ASHIKAGA, KEIICHI ; NAKAGAWA, SUSUMU ; HAYASHIDA, KIYOSHI ; KUGIMIYA, HIROSHI</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4043-5c6691fbf53059c28575b976e515e527bef1f86037c9cfa1b4a0f007f885553d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - therapy</topic><topic>Body Temperature</topic><topic>Catheter Ablation - instrumentation</topic><topic>Catheter Ablation - methods</topic><topic>Catheterization - instrumentation</topic><topic>Catheterization - methods</topic><topic>Equipment Design</topic><topic>esophageal cooling</topic><topic>Esophagus - physiology</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic - methods</topic><topic>Pilot Projects</topic><topic>radiofrequency catheter ablation</topic><topic>Therapeutic Irrigation - methods</topic><topic>Treatment Outcome</topic><topic>Water</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>TSUCHIYA, TAKESHI</creatorcontrib><creatorcontrib>ASHIKAGA, KEIICHI</creatorcontrib><creatorcontrib>NAKAGAWA, SUSUMU</creatorcontrib><creatorcontrib>HAYASHIDA, KIYOSHI</creatorcontrib><creatorcontrib>KUGIMIYA, HIROSHI</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>TSUCHIYA, TAKESHI</au><au>ASHIKAGA, KEIICHI</au><au>NAKAGAWA, SUSUMU</au><au>HAYASHIDA, KIYOSHI</au><au>KUGIMIYA, HIROSHI</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water-Irrigated Intraesophageal Balloon: A Pilot Study</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2007-02</date><risdate>2007</risdate><volume>18</volume><issue>2</issue><spage>145</spage><epage>150</epage><pages>145-150</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><notes>ark:/67375/WNG-PNZ1JDC4-P</notes><notes>ArticleID:JCE693</notes><notes>istex:66A9727CFF3CD7EDAA296C1AEE3537F9B42F7281</notes><notes>Manuscript received 31 August 2006; Revised manuscript received 5 October 2006; Accepted for publication 6 October 2006.</notes><notes>Dr. Tsuchiya is a member of the advisory board of Nihon Kohden.</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><abstract>Introduction: A left atrioesophageal fistula is an uncommon but devastating complication that may occur during atrial fibrillation (AF) ablation, and may be due to thermal injury occurring during the radiofrequency (RF) ablation. We examined the feasibility of an esophageal cooling (ECO) method using a cooled water‐irrigated intraesophageal balloon (IB).
Methods and Results: Eight patients with drug‐refractory AF underwent RF catheter ablation to encircle the ipsilateral pulmonary veins. During the RF ablation at the posterior left atrium, the esophageal lumen was cooled using a 9‐Fr. IB catheter with a balloon length of 40 mm and diameter of 10 mm, in which cooled water, with a water temperature of 4.5 ± 3.1 °C, was irrigated while the luminal esophageal temperature (LET) was measured with an intraesophageal probe placed at a site close to the tip of the ablation catheter. In the control, the LET increased from 36.4 ± 0.8 °C to 40.5 ± 1.7 °C within 26.1 ± 8.2 seconds during 3.9 ± 1.2 RF energy applications, whereas with the ECO the LET decreased to 30.2 ± 2.9 °C at baseline (P<0.01 vs control), and increased only to 33.5 ± 2.9 °C (P<0.01 vs control) at most, within 30 seconds during 3.9 ± 1.2 RF energy applications. All pulmonary veins were successfully isolated in all patients without any complications. During a follow‐up period of 3.1 ± 1.2 months, no esophageal injuries were observed and all but one patient have been free from any symptoms.
Conclusions: Use of an IB successfully lowers LET. This might have the potential of preventing esophageal injury, although further study is required.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>17239114</pmid><doi>10.1111/j.1540-8167.2006.00693.x</doi><tpages>6</tpages></addata></record> |
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| subjects | atrial fibrillation Atrial Fibrillation - therapy Body Temperature Catheter Ablation - instrumentation Catheter Ablation - methods Catheterization - instrumentation Catheterization - methods Equipment Design esophageal cooling Esophagus - physiology Female Humans Male Middle Aged Monitoring, Physiologic - methods Pilot Projects radiofrequency catheter ablation Therapeutic Irrigation - methods Treatment Outcome Water |
| title | Atrial Fibrillation Ablation with Esophageal Cooling with a Cooled Water-Irrigated Intraesophageal Balloon: A Pilot Study |
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