Impact of Active Esophageal Cooling on Fluoroscopy Usage During Left Atrial Ablation

Zagrodzky, Jason; Bailey, Shane; Shah, S. M.; Kulstad, Erik

doi:10.19102/icrm.2021.121101

Cited by 15 publications

(11 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Different methods have been proposed for this purpose which broadly may be considered ‘reactive’ (apply in response to an elevated oesophageal temperature) or ‘proactive’ cooling (pre-emptively cool prior to any risk of thermal injury). 35 Reduced procedure time, 36 fluoroscopy, 37 and overall cost 38 and no reduction in ablation efficacy, efficiency, and safety 39 were some of the benefits highlighted for dedicated active cooling devices. In turn, a recent systematic review and meta-analysis found that oesophageal cooling did not reduce the overall risk of any oesophageal injury compared to control.…”

Section: Strategies To Target the Spb By Percutaneous Radiofrequency ...mentioning

confidence: 99%

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Tonko,

Silberbauer,

Mann

2023

Europace

View full text Add to dashboard Cite

Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann’s bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical ‘cut-and-sew’ techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.

show abstract

Section: Strategies To Target the Spb By Percutaneous Radiofrequency ...mentioning

confidence: 99%

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Tonko,

Silberbauer,

Mann

2023

Europace

View full text Add to dashboard Cite

show abstract

“…The general procedures utilized by operators at the study sites have been previously described. [10,11] All patients were treated under general anesthesia for their ablation procedure. Electrophysiologist physicians at all sites performed primarily wide area circumferential pulmonary vein isolation with additional posterior wall isolation dependent on physician practice.…”

Section: Ablation Proceduresmentioning

confidence: 99%

“…[7] A commercially available esophageal cooling device has demonstrated even greater e cacy at reducing severe esophageal lesions during RF ablation, [8,9] resulting in increased adoption of this approach and a growing number of investigations into its effects on procedural factors. [10,11] One outcome that has not been evaluated is the effect of active esophageal cooling on long-term procedural outcomes. The earliest mathematical model of esophageal cooling raised the question of whether the use of an expandable cooled balloon in the esophagus could reduce the ability to achieve transmural lesions in the atrium.…”

Section: Introductionmentioning

confidence: 99%

Improved One-year Outcomes After Active Cooling During Left Atrial Radiofrequency Ablation

Joseph

Nazari

Zagrodzky

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare one-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation.Methods: Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at one-year follow up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling and those treated with traditional LET monitoring using Kaplan-Meier estimates.Results: A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes, and 260 received active cooling. Mean age was 66.8 (SD +/-10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At one-year follow-up, KM estimates for freedom from AF were 58.2% for LET monitored patients and 72.2% for actively cooled patients, for absolute increase in freedom from AF of 14% with active esophageal cooling (P=.03).Conclusions: In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at one-year was found in patients treated with active esophageal cooling when compared to patients that received LET monitoring.

show abstract

“…Rapid adoption of this practice has resulted in the accumulation of data showing a range of ancillary benefits as well. For example, use of active esophageal cooling has been shown to have a significant reduction in fluoroscopy requirements 3. In addition, our group and others recently presented data showing reduced procedure times as well as improvement in long-term freedom from dysrhythmia with cooling, presumably due to the improved ability to perform point-to-point ablation without interruption from local overheating 4…”

mentioning

confidence: 93%

Preventing atrioesophageal fistula

Braun

Martin

Willms

et al. 2023

Jaapa

View full text Add to dashboard Cite

We enjoyed reading "Atrioesophageal fi stula: A rare complication of catheter ablation for atrial fi brillation," by Sarah Jones, PA-C, and Areeba Kara, MD, MS, in the June issue. We would like to commend the authors for this informative report, and add further background and data on the topic, particularly with regard to the area of prevention, because as the authors point out, atrioesophageal fi stula has a mortality up to 80%, and cases often present with chest pain and undifferentiated sepsis, making diagnosis diffi cult.Focusing on the prevention of esophageal injuries such as atrioesophageal fi stula is ideal. Growing data have supported the use of active esophageal cooling, as opposed to luminal esophageal temperature (LET) monitoring. For example, recent randomized studies have shown greater esophageal injury with LET monitoring than without. 1 On the other hand, the impact study showed a reduction of 83% in esophageal injury with active esophageal cooling compared with LET monitoring. 2 Rapid adoption of this practice has resulted in the accumulation of data showing a range of ancillary benefi ts as well. For example, use of active esophageal cooling has been shown to have a signifi cant reduction in fl uoroscopy requirements. 3 In addition, our group and others recently presented data showing reduced procedure times as well as improvement in long-term freedom from dysrhythmia with cooling, presumably due to the improved ability to perform point-topoint ablation without interruption from local overheating. 4 JAAPA

show abstract

Impact of Active Esophageal Cooling on Fluoroscopy Usage During Left Atrial Ablation

Cited by 15 publications

References 26 publications

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Improved One-year Outcomes After Active Cooling During Left Atrial Radiofrequency Ablation

Preventing atrioesophageal fistula

Contact Info

Product

Resources

About