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PV isolation guided by esophageal visualization with a tailored ablation strategy for the avoidance of esophageal thermal injury: a randomized trial
- Source :
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 58(2)
- Publication Year :
- 2019
-
Abstract
- Radiofrequency ablation along the posterior wall of the left atrium may lead to atrioesophageal fistula due to esophageal thermal injury. The purpose of our study was to prospectively investigate whether ablation guided by soluble contrast esophageal visualization (SCEV) reduces injury during atrial fibrillation (AF) ablation. Seventy-eight patients with paroxysmal AF undergoing circumferential pulmonary vein isolation (PVI) were randomized to a SCEV group (n = 39) and control group without visualization (n = 39). Cine imaging of the esophagus was performed during soluble contrast swallowing at the beginning of ablation, after adjacent ipsilateral PVI and at the end of the procedure. The ablation lesion set was modified to avoid radiofrequency delivery within the contrast esophagram boundaries. In the control group, a single final ingestion was performed at the end of the procedure. Esophageal injury was assessed by esophagogastroscopy within 24 h in all patients. In the control group, the ablation lesion crossed over the esophagus in 46.2% of patients, whereas in SCEV group, the ablation line violated the boundaries of the esophagus unavoidably in 15.4% of patients (confidence interval (CI); 1.61–13.98, p = 0.003). The incidence of esophageal injury was significantly lower in patients that underwent ablation with SCEV (5.1% vs. 20.5%, CI; 0.04–1.06, p = 0.042). Regardless of randomization group, patients who received ablation which overlapped the esophagus had a higher incidence of esophageal injury compared with those without overlap (37.5 vs. 1.9%, CI; 3.73–271.37, p = 0.000). Esophageal contrast visualization helps to reduce the potential for esophageal injury during paroxysmal AF ablation. This simple procedural adjunct has important implications to improve safety of paroxysmal AF ablation procedures globally.
- Subjects :
- medicine.medical_specialty
Randomization
Radiofrequency ablation
medicine.medical_treatment
030204 cardiovascular system & hematology
Pulmonary vein
law.invention
Lesion
03 medical and health sciences
0302 clinical medicine
Esophagus
Swallowing
law
Physiology (medical)
Atrial Fibrillation
medicine
Humans
030212 general & internal medicine
Heart Atria
business.industry
Atrial fibrillation
medicine.disease
Ablation
medicine.anatomical_structure
Treatment Outcome
Pulmonary Veins
Catheter Ablation
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15728595
- Volume :
- 58
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
- Accession number :
- edsair.doi.dedup.....de1c09e03a3db5b8f8aadd9072b0a6ba