Incidence of esophageal lesions in patients undergoing ablation for atrial fibrillation with multipolar pulmonary vein ablation catheter (PVAC-GOLD®)
Keywords:
Atrial Fibrillation, Endoscopy, Digestive System, Esophageal Fistula, Esophageal Perforation, Catheter AblationAbstract
Background: Esophageal lesions are described as a complication after ablation for atrial fibrillation. The studies evaluating the development of esophageal lesions in ablation due to atrial fibrillation had unipolar mode radiofrequency energy source using an irrigated catheter. A multipolar pulmonary vein ablation catheter (PVAC-GOLD®) is currently available, which uses phase-in cycles of energy (Duty-Cycled Phased RF). This study aims to evaluate the occurrence of esophageal lesions in patients undergoing ablations due to atrial fibrillation using the PVAC-GOLD® catheter. Method: Between August 2014 and August 2017, patients undergoing ablation due to symptomatic atrial fibrillation with the use of the PVAC-GOLD® catheter were included in the study. Upper digestive endoscopy was performed in the postoperative period to determine the presence of thermal esophageal lesions associated to the procedure. Results: A total of 117 patients, with mean age of 54.8 years, predominantly males, were included in the study. Of these patients, only 2 presented thermal esophageal lesions diagnosed by endoscopy. Conclusion: Esophageal lesion seems to be an unusual finding in patients undergoing electrical isolation of the pulmonary veins sing the multipolar pulmonary vein ablation catheter (PVAC-GOLD®).
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References
1. Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg. 2001;122(6):1239-40. PMID: 11726904 DOI: http://dx.doi.org/10.1067/ mtc.2001.118041
2. Scanavacca MI, D’ávila A, Parga J, Sosa E. Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(8):960-2. DOI: http://dx.doi. org/10.1046/j.1540-8167.2004.04083.x
3. Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
Circulation. 2004;109(22):2724-6. PMID: 15159294 DOI: http://dx.doi. org/10.1161/01.CIR.0000131866.44650.46
4. Ghia KK, Chugh A, Good E, et al. A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol. 2009;24(1):33-6. DOI: http://dx.doi. org/10.1007/s10840-008-9307-1
5. Cummings JE, Schweikert RA, Saliba WI, et al. Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006;144(8):572-4. PMID: 16618954 DOI: http://dx.doi. org/10.7326/0003-4819-144-8-200604180-00007
6. Schmidt M, Nölker G, Marschang H, et al. Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace. 2008;10(2):205-9. DOI: http://dx.doi. org/10.1093/europace/eun001
7. Aryana A, O’Neill PG, Pujara DK, et al. Impact of irrigation flow rate and intrapericardial fluid on cooled-tip epicardial radiofrequency ablation. Heart Rhythm. 2016;13(8):1602-11. DOI: http://dx.doi.org/10.1016/j. hrthm.2016.05.008
8. Weber S, Höher M, Schultes D. First results and follow-up of a secondgeneration circular mapping and ablation catheter. J Interv Card Electrophysiol. 2016;47(2):213-9. DOI: http://dx.doi.org/10.1007/s10840- 016-0140-7
9. Müller P, Dietrich JW, Halbfass P, et al. Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes. Heart Rhythm. 2015;12(7):1464-9. DOI: http:// dx.doi.org/10.1016/j.hrthm.2015.04.005
10. MacGregor DA, Zvara DA, Treadway RM Jr, et al. Late presentation of esophageal injury after transesophageal echocardiography. Anesth Analg. 2004;99(1):41-4. PMID: 15281500 DOI: http://dx.doi. org/10.1213/01.ANE.0000120085.40108.24
11. Mathur SK, Singh P. Transoesophageal echocardiography related complications. Indian J Anaesth. 2009;53(5):567-74.
12. Lemola K, Sneider M, Desjardins B, et al. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004;110(24):3655-60. PMID: 15569839 DOI: http://dx.doi.org/10.1161/01.CIR.0000149714.31471.FD
13. Alaeddini J, Wood MA, Parvez B, Pathak V, Wong KA, Ellenbogen KA. Site localization and characterization of pain during radiofrequency ablation
of the pulmonary veins. Pacing Clin Electrophysiol. 2007;30(10):1210-4. DOI: http://dx.doi.org/10.1111/j.1540-8159.2007.00842.x
14. Leite LR, Santos SN, Maia H, et al. Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study. Circ Arrhythm Electrophysiol. 2011;4(2):149-56. DOI: http://dx.doi. org/10.1161/CIRCEP.110.960328
15. Good E, Oral H, Lemola K, et al. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005;46(11):2107-10. DOI: http://dx.doi.org/10.1016/j.jacc.2005.08.042
16. Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43(11):2044-53. DOI: http://dx.doi. org/10.1016/j.jacc.2003.12.054
17. Marrouche N, Wazni OM, Martin DO, et al. Response to pharmacological challenge of dissociated pulmonary vein rhythm. J Cardiovasc Electrophysiol. 2005;16(2):122-6. DOI: http://dx.doi.org/10.1046/j.1540- 8167.2005.40333.x
18. Cummings JE, Schweikert RA, Saliba WI, et al. Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation. 2005;112(4):459-64. PMID: 16027254 DOI: http://dx.doi.org/10.1161/CIRCULATIONAHA.104.509612
19. Redfearn DP, Trim GM, Skanes AC, et al. Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2005;16(6):589-93.
20. Marrouche NF, Guenther J, Segerson NM, et al. Randomized comparison between open irrigation technology and intracardiac-echo-guided energy delivery for pulmonary vein antrum isolation: procedural parameters, outcomes, and the effect on esophageal injury. J Cardiovasc Electrophysiol. 2007;18(6):583-8. DOI: http://dx.doi.org/10.1111/j.1540- 8167.2007.00879.x
21. Bunch TJ, Bruce GK, Johnson SB, Sarabanda A, Milton MA, Packer DL. Analysis of catheter-tip (8-mm) and actual tissue temperatures achieved during radiofrequency ablation at the orifice of the pulmonary vein. Circulation. 2004;110(19):2988-95. DOI: http://dx.doi.org/10.1161/01. CIR.0000146905.19945.99
22. Melo SL, Scanavacca MI, Darrieux FCC, Hachul DT, Sosa EA. Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm. Arq Bras Cardiol. 2007;88(3):273-8. DOI: http://dx.doi.org/10.1590/S0066- 782X2007000300004
23. Zellerhoff S, Lenze F, Ullerich H, et al. Esophageal and Mediastinal Lesions Following Multielectrode Duty-Cycled Radiofrequency Pulmonary Vein Isolation: Simple Equals Safe? Pacing Clin Electrophysiol. 2016;39(4):316-20.
2. Scanavacca MI, D’ávila A, Parga J, Sosa E. Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(8):960-2. DOI: http://dx.doi. org/10.1046/j.1540-8167.2004.04083.x
3. Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
Circulation. 2004;109(22):2724-6. PMID: 15159294 DOI: http://dx.doi. org/10.1161/01.CIR.0000131866.44650.46
4. Ghia KK, Chugh A, Good E, et al. A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol. 2009;24(1):33-6. DOI: http://dx.doi. org/10.1007/s10840-008-9307-1
5. Cummings JE, Schweikert RA, Saliba WI, et al. Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006;144(8):572-4. PMID: 16618954 DOI: http://dx.doi. org/10.7326/0003-4819-144-8-200604180-00007
6. Schmidt M, Nölker G, Marschang H, et al. Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace. 2008;10(2):205-9. DOI: http://dx.doi. org/10.1093/europace/eun001
7. Aryana A, O’Neill PG, Pujara DK, et al. Impact of irrigation flow rate and intrapericardial fluid on cooled-tip epicardial radiofrequency ablation. Heart Rhythm. 2016;13(8):1602-11. DOI: http://dx.doi.org/10.1016/j. hrthm.2016.05.008
8. Weber S, Höher M, Schultes D. First results and follow-up of a secondgeneration circular mapping and ablation catheter. J Interv Card Electrophysiol. 2016;47(2):213-9. DOI: http://dx.doi.org/10.1007/s10840- 016-0140-7
9. Müller P, Dietrich JW, Halbfass P, et al. Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes. Heart Rhythm. 2015;12(7):1464-9. DOI: http:// dx.doi.org/10.1016/j.hrthm.2015.04.005
10. MacGregor DA, Zvara DA, Treadway RM Jr, et al. Late presentation of esophageal injury after transesophageal echocardiography. Anesth Analg. 2004;99(1):41-4. PMID: 15281500 DOI: http://dx.doi. org/10.1213/01.ANE.0000120085.40108.24
11. Mathur SK, Singh P. Transoesophageal echocardiography related complications. Indian J Anaesth. 2009;53(5):567-74.
12. Lemola K, Sneider M, Desjardins B, et al. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004;110(24):3655-60. PMID: 15569839 DOI: http://dx.doi.org/10.1161/01.CIR.0000149714.31471.FD
13. Alaeddini J, Wood MA, Parvez B, Pathak V, Wong KA, Ellenbogen KA. Site localization and characterization of pain during radiofrequency ablation
of the pulmonary veins. Pacing Clin Electrophysiol. 2007;30(10):1210-4. DOI: http://dx.doi.org/10.1111/j.1540-8159.2007.00842.x
14. Leite LR, Santos SN, Maia H, et al. Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study. Circ Arrhythm Electrophysiol. 2011;4(2):149-56. DOI: http://dx.doi. org/10.1161/CIRCEP.110.960328
15. Good E, Oral H, Lemola K, et al. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005;46(11):2107-10. DOI: http://dx.doi.org/10.1016/j.jacc.2005.08.042
16. Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43(11):2044-53. DOI: http://dx.doi. org/10.1016/j.jacc.2003.12.054
17. Marrouche N, Wazni OM, Martin DO, et al. Response to pharmacological challenge of dissociated pulmonary vein rhythm. J Cardiovasc Electrophysiol. 2005;16(2):122-6. DOI: http://dx.doi.org/10.1046/j.1540- 8167.2005.40333.x
18. Cummings JE, Schweikert RA, Saliba WI, et al. Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation. 2005;112(4):459-64. PMID: 16027254 DOI: http://dx.doi.org/10.1161/CIRCULATIONAHA.104.509612
19. Redfearn DP, Trim GM, Skanes AC, et al. Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2005;16(6):589-93.
20. Marrouche NF, Guenther J, Segerson NM, et al. Randomized comparison between open irrigation technology and intracardiac-echo-guided energy delivery for pulmonary vein antrum isolation: procedural parameters, outcomes, and the effect on esophageal injury. J Cardiovasc Electrophysiol. 2007;18(6):583-8. DOI: http://dx.doi.org/10.1111/j.1540- 8167.2007.00879.x
21. Bunch TJ, Bruce GK, Johnson SB, Sarabanda A, Milton MA, Packer DL. Analysis of catheter-tip (8-mm) and actual tissue temperatures achieved during radiofrequency ablation at the orifice of the pulmonary vein. Circulation. 2004;110(19):2988-95. DOI: http://dx.doi.org/10.1161/01. CIR.0000146905.19945.99
22. Melo SL, Scanavacca MI, Darrieux FCC, Hachul DT, Sosa EA. Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm. Arq Bras Cardiol. 2007;88(3):273-8. DOI: http://dx.doi.org/10.1590/S0066- 782X2007000300004
23. Zellerhoff S, Lenze F, Ullerich H, et al. Esophageal and Mediastinal Lesions Following Multielectrode Duty-Cycled Radiofrequency Pulmonary Vein Isolation: Simple Equals Safe? Pacing Clin Electrophysiol. 2016;39(4):316-20.
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Published
2018-04-01
How to Cite
David da Silva, R. ., Arantes Filho, R. C. ., Araújo, L. M. da C. ., Araújo, L. M. da C. ., Margalho, C. S. ., Macedo da Rocha, J. ., Seixas, T. N. ., Maria, H. C. ., & Péres, A. K. . (2018). Incidence of esophageal lesions in patients undergoing ablation for atrial fibrillation with multipolar pulmonary vein ablation catheter (PVAC-GOLD®). JOURNAL OF CARDIAC ARRHYTHMIAS, 31(2), 56–61. Retrieved from https://jca.emnuvens.com.br/jca/article/view/58
