High-Resolution Infrared Thermal Imaging of the Esophagus During Atrial Fibrillation Ablation as a Predictor of Endoscopically Detected Thermal Lesions

Deneke, Thomas; Nentwich, Karin; Berkovitz, Artur; Sonne, Kai; Ene, Elena; Павлов, Б. Н.; Fochler, Franziska; Bötsch, Anne-Katrin; Kühn, Rainer; Halbfaß, Philipp

doi:10.1161/circep.118.006681

Cited by 36 publications

(37 citation statements)

References 24 publications

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“…With this very precise measurement, the peak temperature was shown to be in an excellent predictor for the development of EDEL. 17 Different other strategies have been evaluated to reduce the risk of thermal injury during AF ablations. For example, multisensor expandable probes, 18 ablation catheter with increased irrigation channels 19 and mechanical displacement of esophagus 20 Another important finding was the independence of recurrence rates of AF after ablation from the esophageal position or temperature.…”

Section: Discussionmentioning

confidence: 99%

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Stauber

Kornej

Bollmann

et al. 2020

Pacing Clinical Electrophis

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Background Thermolesions are a dangerous complication of atrial fibrillation (AF) ablation. We aimed to assess the reasons for thermolesions and the effect of esophageal position on recurrences. Methods The study included consecutive patients undergoing AF catheter ablation at Heart Center Leipzig between January and September 2014. We collected data of esophagus localization, temperature, endoscopy, and follow‐up. Results The study included 645 patients into analyses. A total of 626 (97.2%) received a temperature probe. Esophageal position was categorized: (A) behind left pulmonary veins, (B) left ostial, (C) in the middle of left atrium, (D) right ostial, and (E) behind right pulmonary veins. The most frequent esophageal position was B‐C (n = 201, 32.1%), followed by B (n = 161, 25.7%), and C (n = 147, 23.5%). The temperature was highest in A‐B positions (42.04°C) and in D‐E positions (41.70°C). There was a significant correlation between the endoscopically detected esophageal lesions (EDEL) and the esophageal position (r² = −.115, P = .004) and the esophageal temperature (r² = .162, P = .000), but not with body mass index (BMI) (r² = −.016, P = .688). Additional substrate modification in the left atrium resulted in significantly higher esophageal temperatures (P < .001) and more frequent EDEL (P = .049). An EDEL was found in 15 patients (2.3% of all patients, 5.6% of patients receiving endoscopy). Of those, the median esophageal temperature was 41.8°C (interquartile range [IQR]: 41.2‐42.4). Neither esophageal position nor temperature during ablation was associated with arrhythmia recurrences (both P > .400). Conclusions EDEL depended on the esophageal position and temperature, but not on BMI. Esophageal position and intraluminal temperature during ablation had no effect on recurrences.

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Section: Discussionmentioning

confidence: 99%

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Stauber

Kornej

Bollmann

et al. 2020

Pacing Clinical Electrophis

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“…EDEL have been identified in between 0% and up to 40% of patients after AF ablation depending on ablation energy, type of ablation catheter, use of catheter‐tip irrigation, use of temperature probes, and depending on the indication and timing of postprocedural endoscopy . Endoscopy is considered the gold standard for detecting thermal esophageal damage and category 2 EDEL are the endoscopic findings in patients with increased risk of perforating esophageal injury like atrioesophageal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…EE was performed by experienced operators (having performed over 1000 post AF–ablation endoscopies each) within 1 to 3 days after ablation to assess for the presence and extent of endoscopically detected esophageal lesions (EDEL). EDEL was defined as a typical endoscopical finding of the esophageal mucosa in an area neighboring the LA and was classified as either category 1 lesion (mild: erythema/erosion or small ulcers ≤5 mm diameter) or category 2 (severe) lesion (ulcer >5 mm diameter) as previously reported …”

Section: Methodsmentioning

confidence: 99%

“…We did not use luminal esophageal temperature probes as they seem not to be predictive for the occurrence of EDELs and have not been clearly related to reduced atrioesophageal fistula or EDEL rates. Conflicting data regarding the potential of temperature probes to reduce the risk of EDEL have been published so far . A recent meta‐analysis evaluating the prevalence of and strategies to prevent esophageal injury after atrial fibrillation ablation identified 56 studies for potential inclusion in the analysis.…”

Section: Limitationsmentioning

confidence: 99%

“…Furthermore, a major limitation of currently used temperature probes is that esophageal tissue temperature rises might be detected too late to prevent thermal esophageal damage by interrupting RF energy application at LA posterior wall. A high‐definition accurate temperature probe using infrared technology has been evaluated in an IDE‐trial (HEAT‐AF) and data in regard to identify patients at risk for EDEL are promising but further investigations are needed …”

Section: Limitationsmentioning

confidence: 99%

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Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index

Halbfaß

Berkovitz

Павлов

et al. 2019

Cardiovasc electrophysiol

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Introduction Ablation index (AI), a novel parameter defining energy application at single ablation lesions, calculated by integration of ablation time, energy, catheter stability, and contact force, has been documented to be associated with effective lesions and higher ablation efficacy. Using a prespecified target AI in addition to acute lesion efficacy may affect local collateral damage like esophageal thermal injury when used for guiding radiofrequency (RF) ablation at the posterior left atrial (LA) wall. Methods and Results Consecutive patients undergoing first AF ablations using AI were included. Ablation energy was reduced to 25 W when ablating at posterior LA wall. Two different individually defined AI target values were used (300 and 350 for posterior wall ablation). Esophageal endoscopy (EE) was performed 1 to 3 days after ablation procedure to document and categorize endoscopically detected esophageal thermal lesion (EDEL). Two‐hundred and eleven consecutive patients with postprocedural EE were included. Incidence of EDEL was 14% (29 of 211 patients; mild category 1 lesions in 22 of 29 patients (76%) and severe category 2 lesions (ulcers > 5 mm) in 7 of 29 patients (24% of EDEL group, 3% of total group). Ablation time at posterior LA wall (9.5 vs 9.0 minutes [P = .67]) was comparable in patients with and without EDEL. Conclusion LA posterior wall RF ablation adopting AI ≤350 was associated with 14% esophageal thermal injury including 3% of severe esophageal thermal ulcers. This incidence is comparable to historic control groups with non AI–guided AF ablation.

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Application of Ultrasound Thermal Imaging for Monitoring Laser Ablation in Ex Vivo Cardiac Tissue

et al. 2019

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Background and Objective Laser ablation can be used to treat atrial fibrillation by thermally isolating pulmonary veins. In this study, we evaluated the feasibility of high‐resolution (<1 mm) ultrasound thermal imaging to monitor spatial temperature distribution during laser ablation on ex vivo cardiac tissue. Study Design/Materials and Methods Laser ablation (808 nm) was performed on five porcine cardiac tissue samples. A thermocouple was used to measure the interstitial tissue temperature during the laser ablation process. Tissue‐strain‐based ultrasound thermal imaging was conducted to monitor the spatial distribution of the temperature in the cardiac tissue. The tissue temperature was estimated from the time shifts of ultrasound signals owing to the changes in the speed of sound and was compared with the measured temperature. The temperature estimation coefficient k of porcine cardiac tissue was calculated from the estimated thermal strain and the measured temperature. The degree of tissue coagulation (temperatures > 50°C) was derived from the estimated temperature and was compared with that of the tested cardiac tissue. Results The estimated tissue temperature using strain‐based ultrasound thermal imaging at a depth of 1 mm agreed with thermocouple measurements. During the 30‐second period of the laser ablation process, the estimated tissue temperature increased from 25 to 70°C at a depth of 0.1 mm, while the estimated temperature at a depth of 1 mm increased up to 46°C. Owing to the uncertainty of the coefficient k, the k value of the porcine cardiac tissue varied from 160 to 220°C with temperature changes of up to 20°C. The estimated coagulation region in the ultrasound thermal imaging was 20% wider (+0.6 mm) but 9% shallower (−0.1 mm) than the measured region of the ablated porcine cardiac tissue. Conclusions The current study demonstrated the feasibility of temperature monitoring with the use of ultrasound thermal imaging during the laser ablation on ex vivo porcine cardiac tissue. The high‐resolution ultrasound thermal imaging could map the spatial distribution of the tissue temperature. The proposed method can be used to monitor the temperature and thermal coagulation to achieve effective laser ablation for atrial fibrillation. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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High-Resolution Infrared Thermal Imaging of the Esophagus During Atrial Fibrillation Ablation as a Predictor of Endoscopically Detected Thermal Lesions

Cited by 36 publications

References 24 publications

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index

Application of Ultrasound Thermal Imaging for Monitoring Laser Ablation in Ex Vivo Cardiac Tissue

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