Anatomical predisposing factors of transmural thermal injury after pulmonary vein isolation

Kaneshiro, Takashi; Matsumoto, Yoshiyuki; Nodera, Minoru; Kamioka, Masashi; Kamiyama, Yoshiyuki; Yoshihisa, Akiomi; Ohkawara, Hiroshi; Suzuki, Hitoshi; Takeishi, Yasuchika

doi:10.1093/europace/eux185

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…Because the rate of an AEF is not that high, there are several reports that regarded ELs as a surrogate marker of an AEF. The incidence of ELs varies among the reports ranging from 2.2% to 54% of AF ablation cases with the RF energy . In some reports, several predictors of ELs such as the BMI, distance between the left atrium and esophagus, and general anesthesia have been identified .…”

Section: Discussionmentioning

confidence: 99%

“…GH has been reported to involve periesophageal nerve injury, and occurs in 5.7–14.5% of patients who undergo RF catheter ablation of AF . The incidence of GH after the PVI with the CB has been demonstrated to occur in 17.3% of patients .…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of ELs varies among the reports ranging from 2.2% to 54% of AF ablation cases with the RF energy. [18][19][20][21][22][23][24] In some reports, several predictors of ELs such as the BMI, distance between the left atrium and esophagus, and general anesthesia have been identified. [19][20][21][22] Our results regarding the BMI were consistent with the previously reported data, which said that the BMI is lower in patients with ELs.…”

Section: Serious Adverse Events Affecting the Esophagus Associated Wimentioning

confidence: 99%

“…GH has been reported to involve periesophageal nerve injury, and occurs in 5.7-14.5% of patients who undergo RF catheter ablation of AF. 22,24 The incidence of GH after the PVI with the CB has been demonstrated to occur in 17.3% of patients. 9 In the present study, GH was detected in 15.8% of the patients who underwent a PVI and LAPW isolation with the CB, which was comparable to the previous reported data.…”

Section: Serious Adverse Events Affecting the Esophagus Associated Wimentioning

confidence: 99%

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Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Shigeta

Okishige

Aoyagi

et al. 2019

Pacing Clinical Electrophis

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Background The cryoballoon (CB) can be utilized for extra pulmonary vein (PV) ablation such as for a left atrial (LA) posterior wall (LAPW) isolation. However, scrutiny of the esophageal injuries during the LAPW isolation has never been performed. We sought to thoroughly investigate the esophageal lesions (ELs) and gastric hypomotility (GH) caused by an LAPW isolation using a CB. Methods A total of 101 persistent atrial fibrillation patients who underwent an LAPW isolation using a CB were enrolled. The CB was applied on the roof and bottom area of the LAPW after a PV isolation. The luminal esophageal temperature (LET) was monitored by a thermistor probe during the CB applications. When the LET reached 15°C, the freezing application was prematurely interrupted. Esophagogastroscopy was performed on the next day following the ablation. Results All PVs were successfully isolated in all patients. A successful LAPW isolation solely with CB ablation was performed in 72 (71.3%) patients. Cryofreezing applications were prematurely interrupted due to low LETs in 49 (48.5%) patients predominantly during the LA bottom line ablation. ELs and GH were observed in 11 (10.9%) and 16 patients (15.8%), respectively. The nadir LET tended to be lower in patients with ELs and GH than in those without (ELs: 14.8 ± 4.5°C vs 17.4 ± 6.0°C, P = 0.17; GH: 15.5 ± 4.5°C vs 17.5 ± 6.1°C, P = 0.23, respectively). Conclusions Esophageal complications such as ELs and GH occur during the LAPW isolation with a CB. There was no reliable predictor of those adverse events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Serious Adverse Events Affecting the Esophagus Associated Wimentioning

confidence: 99%

Section: Serious Adverse Events Affecting the Esophagus Associated Wimentioning

confidence: 99%

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Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Shigeta

Okishige

Aoyagi

et al. 2019

Pacing Clinical Electrophis

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“…The clinical success of radiofrequency ablation (RFA) for atrial fibrillation depends on achieving a transmural lesion, that is, a lesion that occupies the entire thickness of the atrial wall . Since this can be as little as 2 mm , and may be close to the esophagus , it is thus crucial to ensure a specific lesion depth. Different technologies have attempted to evaluate lesion size , but the correlation of their parameters with lesion size was seen to be low.…”

Section: Introductionmentioning

confidence: 99%

Relation between denaturation time measured by optical coherence reflectometry and thermal lesion depth during radiofrequency cardiac ablation: Feasibility numerical study

González-Suárez¹,

Herranz²,

Berjano

et al. 2017

Lasers Surg Med

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Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

Nehashi,

Kaneshiro,

Nodera

et al. 2023

Journal of Arrhythmia

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BackgroundThis study thought to elucidate the anatomical features that can predict an epicardial connection (EC) between the right pulmonary vein (RPV) and right atrium.MethodsWe retrospectively analyzed 251 consecutive patients undergoing initial radiofrequency pulmonary vein isolation. We defined EC as present when RPV could not be isolated with circumferential ablation and additional ablation for the conduction gap if needed, and RPV isolation could be achieved by ablation for the earliest activation site >10 mm inside the initial ablation line. Using computed tomography data, we evaluated the RPV bifurcation angle, and the area occupation ratio of the carina region to the RPV antrum (ARC) for predicting EC. In subjects with EC undergoing RPV activation mapping after circumferential ablation, the correlation between conduction delay and bipolar/unipolar potential voltage in the carina region was investigated.ResultsThere were ECs in 45 out of 251 patients (17.9%). The RPV bifurcation angle (47.7° vs. 38.8°, p < .001) and ARC (37.2% vs. 29.7%, p < .001) were significantly greater in the EC (+) group. Multivariate logistic regression analysis revealed that RPV bifurcation angle (odds ratio [OR]: 1.994, p = .002) and ARC (OR: 3.490, p = .013) were independent predictors of EC. In nine patients with EC undergoing carina region mapping, the unipolar potential voltage was correlated with conduction delay in RPV with EC (R = −0.401, p < .001).ConclusionAnatomical features suggesting a wider RPV carina region could predict the presence of EC, and potential with high voltage could be helpful for detecting EC connection sites.

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Anatomical predisposing factors of transmural thermal injury after pulmonary vein isolation

Abstract: The anatomical proximities of the LA posterior wall, LIPV, and descending Ao surrounding the oesophagus are strongly associated with the prevalence of TTI.

Cited by 17 publications

References 20 publications

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Relation between denaturation time measured by optical coherence reflectometry and thermal lesion depth during radiofrequency cardiac ablation: Feasibility numerical study

Characteristics of right pulmonary vein with an epicardial connection needing additional carina ablation for isolation

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