The Extent of Mechanical Esophageal Deviation to Avoid Esophageal Heating During Catheter Ablation of Atrial Fibrillation

JACC. Clinical Electrophysiology
Chandrasekar PalaniswamyVivek Y Reddy

Abstract

This study sought to determine the extent of lateral esophageal displacement required during mechanical esophageal deviation (MED) and to eliminate luminal esophageal temperature elevation (LETElev) during pulmonary vein (PV) isolation. MED is a conceptually attractive strategy of minimizing esophageal injury while allowing uninterrupted energy delivery along the posterior left atrium during PV isolation. MED was performed using a malleable metal stylet within a plastic tube placed within the esophagus. Barium was instilled to characterize the trailing esophageal edge. For each MED attempt, the MEDEffective, defined as the distance from the trailing esophageal edge-to-ablation line, was correlated to occurrences of LETElev. In 114 consecutive patients/221 PV pairs undergoing MED (age 62.1 ± 11 years, 75% men, 62%/38% paroxysmal/persistent AF), esophageal stretching invariably occurred such that the esophageal edge trailed behind the plastic tube. MEDEffective distances of 0 mm to 10 mm, 10 mm to 15 mm, 15 mm to 20 mm or >20 mm were achieved in 60 (27.1%), 64 (29%), 48 (21.7%), and 49 (22.2%) attempts, respectively. Overall, LET elevation >38°C occurred in 81 of 221 (36.7%) PV pairs. The incidence of LETElev among the 4 groups w...Continue Reading

References

Sep 15, 2011·Journal of Cardiovascular Electrophysiology·Jacob S KoruthAlexander Mittnacht
Aug 21, 2013·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Sheldon M SinghVivek Y Reddy
Feb 17, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·V Nam TranVivek Y Reddy

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Citations

May 6, 2020·Journal of Cardiovascular Electrophysiology·Mohamad N El Moheb, Marwan M Refaat
May 12, 2020·Pacing and Clinical Electrophysiology : PACE·Ruhong JiangChenyang Jiang
Apr 24, 2020·Journal of Cardiovascular Electrophysiology·Fabrizio R AssisHarikrishna Tandri
Nov 23, 2019·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Jin IwasawaVivek Y Reddy
Apr 11, 2018·Arrhythmia & Electrophysiology Review·Jorge RomeroLuigi Di Biase
Feb 24, 2021·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Cory M TschabrunnPasquale Santangeli
Mar 4, 2021·Arquivos brasileiros de cardiologia·Eduardo B Saad, Andre d'Avila
May 25, 2021·HeartRhythm Case Reports·Xiaoke Liu, Shiau-Ing Wu
May 25, 2021·HeartRhythm Case Reports·Lisa W M Leung, Mark M Gallagher

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