医学
烧蚀
肺静脉
心房颤动
导管消融
胃窦
无症状的
食管
食管癌
瘘管
内科学
心脏病学
外科
癌症
胃
作者
Bettina Kirstein,Christian‐H. Heeger,Julia Vogler,Charlotte Eitel,Marcel Feher,Huong‐Lan Phan,Ilias Mushfiq,Anna Traub,Sascha Hatahet,Omar Samara,Behnam Subin,Karl‐Heinz Kuck,Roland Richard Tilz
摘要
Abstract Introduction Atrio‐esophageal fistula after esophageal thermal injury (ETI) is one of the most devastating complications of available energy sources for atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) uses electroporation as a new energy source for catheter ablation with promising periprocedural safety advantages over existing methods due to its unique myocardial tissue sensitivity. In preclinical animal studies, a dose‐dependent esophageal temperature rise has been reported. In the TESO‐PFA registry intraluminal esophageal temperature (TESO) changes in a clinical setting are evaluated. Methods Consecutive symptomatic AF patients (62 years, 67% male, 61% paroxysmal AF, CHA 2 DS 2 Vasc Score 2) underwent first‐time PFA and were prospectively enrolled into our registry. Eight pulse trains (2 kV/2.5 s, bipolar, biphasic, x4 basket/flower configuration each) were delivered to each pulmonary vein (PV). Two extra pulse trains per PV in flower configuration were added for wide antral circumferential ablation. Continuous intraluminal esophageal temperature (TESO) was monitored with a 12‐pole temperature probe. Results Median TESO change was statistically significant and increased by 0.8 ± 0.6°C, p < .001. A TESO increase ≥ 1°C was observed in 10/43 (23%) patients. The highest TESO measured was 40.3°C. The largest TESO difference (∆TESO) was 3.7°C. All patients remained asymptomatic considering possible ETI. No atrio‐esophageal fistula was reported on follow‐up. Conclusion A small but significant intraluminal esophageal temperature rise can be observed in most patients during PFA. TESO rise over 40°C is rare. The clinical implications of the observed findings need to be further evaluated.
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