Background Atrio-esophageal fistula formation subsequent radiofrequency ablation of left atrial tachyarrhythmias
May 15, 2017
Background Atrio-esophageal fistula formation subsequent radiofrequency ablation of left atrial tachyarrhythmias is a rare but devastating complication. Rabbit Polyclonal to FPRL2. Patient and disease characteristics had no influence on ulcer formation. The temperature threshold NSC 95397 of 40°C was reached NSC 95397 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. Conclusion Limitation 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. Background Pulmonary vein antrum isolation using radiofrequency ablation has become an effective therapy in symptomatic patients with atrial fibrillation. Additional linear ablation in the left atrium is performed in persistent atrial fibrillation and atrial flutter. Non-lethal complications such as cardiac perforation stroke and pulmonary vein stenosis have been reported to occur with rates of 1 1.3% 0.2% and 1.3% respectively [1 2 A recently reported complication describes esophageal injury leading to left atrial esophageal fistula. Despite its low incidence (0.03-0.1%) this usually lethal complication is of tremendous clinical importance [3-7]. Other serious esophageal injuries include vagus nerve damage with acute pyloric spasm and gastro-paresis . Different strategies are proposed to avoid esophageal injury. Temperatures and Power configurations NSC 95397 are NSC 95397 small when ablating in the posterior wall structure from the remaining atrium . Visualization from the esophagus by barium swallow or tagging the span of the esophagus by electro-anatomical mapping continues to be proposed to be able to alter ablation lines in regions of close closeness towards the esophagus . A pilot research using an irrigated intraesophageal chilling balloon led to a substantial reduced amount of intraluminal esophageal temperatures [11 12 Post ablation esophageal wall structure adjustments (erosion or ulceration) are reported that occurs in up to 47% of individuals . Real-time temperatures monitoring can identify rapid esophageal heating system during radiofrequency ablation . The purpose of this prospective research was to research the occurrence of thermal esophageal lesions when restricting the intraluminal esophageal temperatures in radiofrequency ablation of remaining atrial tachyarrhythmias. Strategies Study inhabitants NSC 95397 184 consecutive individuals with symptomatic atrial fibrillation or remaining atrial macro-reentrant tachyarrhythmias planned for ablation had been one of them research. All procedures had been performed after obtaining created informed consent authorized by the institutional ethics committee. Pulmonary vein isolation Radiofrequency ablation was performed in mindful sedation (constant intravenous NSC 95397 shot of propofol and intravenous shot of fentanyl) or general anaesthesia (10 individuals). All individuals underwent a pre-procedural magnetic resonance imaging or a computed tomography scan (13 individuals) from the remaining atrium. A transesophageal echocardiogram was performed within 48 hours before the treatment to exclude remaining atrial thrombi and imagine the intraatrial septum. Utilizing a transfemoral venous strategy a multipolar catheter was released in to the coronary sinus. Transseptal puncture was performed under fluoroscopic assistance utilizing a steerable lengthy sheath (Agilis St. Jude Medical Saint Paul MN USA) and a Brockenbrough needle. Intravenous unfractionated heparin was given in boli immediately following transseptal puncture to maintain an activated clotting time of 250-350 s. An anatomic map of the left atrium and the pulmonary veins was created using either the NavX-Ensite system (Endocardial Solutions St. Paul USA) in 153 patients or the CARTO XP system (Biosense Webster Diamond Bar CA USA) in 31 patients. The segmented MRI or CT image of the left atrium was fused with the anatomic map using either the Verismo (Endocardial Solutions Saint Paul MN USA) or CARTO Merge (Biosense Websters Diamond Bar CA USA) software. A 7F esophageal temperature probe (Esotherm Fiab Florence Italy) with 3 consecutive olive shaped.