Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-08-2019 | Atrial Fibrillation

Evaluation of the luminal esophageal temperature behavior during left atrium posterior wall ablation by means of second-generation cryoballoon

Authors: Thiago Guimarães Osório, Saverio Iacopino, Hugo-Enrique Coutiño, Erwin Ströker, Juan Sieira, Francesca Salghetti, Varnavas Varnavas, Muryo Terasawa, Gaetano Paparella, Lucio Capulzini, Riccardo Maj, Yves De Greef, Pedro Brugada, Carlo de Asmundis, Gian-Battista Chierchia

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2019

Abstract

Purpose

The purpose of this study was to clarify the behavior of the luminal esophageal temperature (LET) in a cohort of patients undergoing second-generation cryoballoon (CB-A) for pulmonary vein isolation (PVI) and additional left atrium posterior wall (LAPW) ablation by means of CB-A.

Methods

Thirty patients with symptomatic persistent AF (PersAF), having undergone PVI + LAPW cryoballoon ablation with LET monitoring.

Results

Interruption of the application due to a LET below 15 °C occurred in 5 patients (16.6%), 2 at the LIPV and 3 in the LAPW. The 5 patients underwent gastroscopy the day after ablation. In all individuals, esophageal thermal lesion (ETL) was absent.

Conclusion

The evaluation of LET might be an additional tool in helping to prevent damage to the esophagus during the LAPW ablation with the CB-A by stopping the freeze application when temperature reaches values of < 15 °C.

Chierchia G-B, Di Giovanni G, Ciconte G, de Asmundis C, Conte G, Sieira-Moret J, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace. 2014;16(5):639–44 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24478116.CrossRefPubMed

Corradi D, Callegari S, Maestri R, Ferrara D, Mangieri D, Alinovi R, et al. Differential structural remodeling of the left-atrial posterior wall in patients affected by mitral regurgitation with or without persistent atrial fibrillation: a morphological and molecular study. J Cardiovasc Electrophysiol. 2012;23:271–9.CrossRefPubMed

Roberts-Thomson KC, Stevenson I, Kistler PM, Haqqani HM, Spence SJ, Goldblatt JC, et al. The role of chronic atrial stretch and atrial fibrillation on posterior left atrial wall conduction. In: Hear rhythm, vol. 6; 2009. p. 1109–17.

Markides V, Schilling RJ, Ho SY, Chow AWC, Davies DW, Peters NS. Characterization of left atrial activation in the intact human heart. Circulation. 2003;107:733–9.CrossRefPubMed

Metzner A, Reissmann B, Rausch P, Mathew S, Wohlmuth P, Tilz R, et al. One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol. 2014;7(2):288–92.CrossRefPubMed

Di Giovanni G, Wauters K, Chierchia GB, Sieira J, Levinstein M, Conte G, et al. One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol. 2014;25(8):834–9.CrossRefPubMed

Aryana A, Baker JH, Espinosa Ginic MA, Pujara DK, Bowers MR, O’Neill PG, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: a multicenter experience. Hear Rhythm. Elsevier Inc. 2018;15(8):1121–9. https://doi.org/10.1016/j.hrthm.2018.05.014.CrossRef

Fürnkranz A, Bordignon S, Schmidt B, Böhmig M, Böhmer MC, Bode F, et al. Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Hear Rhythm. 2013;10(6):789–93.CrossRef

Ghosh J, Sepahpour A, Chan KH, Singarayar S, McGuire MA. Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation. Hear Rhythm. 2013;10(5):646–52.CrossRef

10.

Sanders P, Berenfeld O, Hocini M, Jaïs P, Vaidyanathan R, Hsu LF, et al. Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans. Circulation. 2005;112:789–97.CrossRefPubMed

11.

Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43:2044–53.CrossRefPubMed

12.

Rostock T, Rotter M, Sanders P, Jaïs P, Hocini M, Takahashi Y, et al. Fibrillating areas isolated within the left atrium after radiofrequency linear catheter ablation. J Cardiovasc Electrophysiol. 2006;17:807–12.CrossRefPubMed

13.

Kalifa J, Tanaka K, Zaitsev AV, Warren M, Vaidyanathan R, Auerbach D, et al. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation. 2006;113:626–33.CrossRefPubMed

14.

Kuniss M, Greiß H, Pajitnev D, Akkaya E, Deubner N, Hain A, et al. Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation. Europace. 2017;19(7):1109–15.PubMed

15.

Kenigsberg DN, Martin N, Lim HW, Kowalski M, Ellenbogen KA. Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. Hear Rhythm. 2015;12(2):283–90.CrossRef

16.

Pappone C, Oral H, Santinelli V, Vicedomini G, Lang CC, Manguso F, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004;109:2724–6.CrossRefPubMed

17.

Cappato R, Calkins H, Chen S-A, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–8.CrossRefPubMed

18.

Stöckigt F, Schrickel JW, Andrié R, Lickfett L. Atrioesophageal fistula after cryoballoon pulmonary vein isolation. J Cardiovasc Electrophysiol. 2012;23:1254–7.CrossRefPubMed

19.

Kawasaki R, Gauri A, Elmouchi D, Duggal M, Bhan A. Atrioesophageal fistula complicating cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(7):787–92.CrossRefPubMed

20.

Lim HW, Cogert GA, Cameron CS, Cheng VY, Sandler DA. Atrioesophageal fistula during cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(2):208–13.CrossRefPubMed

21.

John RM, Kapur S, Ellenbogen KA, Koneru JN. Atrioesophageal fistula formation with cryoballoon ablation is most commonly related to the left inferior pulmonary vein. In: Hear rhythm, vol. 14; 2017. p. 184–9.

22.

Metzner A, Burchard A, Wohlmuth P, Rausch P, Bardyszewski A, Gienapp C, et al. Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon. In: Circ Arrhythmia Electrophysiol, vol. 6; 2013. p. 769–75.

Title: Evaluation of the luminal esophageal temperature behavior during left atrium posterior wall ablation by means of second-generation cryoballoon
Authors: Thiago Guimarães Osório
Saverio Iacopino
Hugo-Enrique Coutiño
Erwin Ströker
Juan Sieira
Francesca Salghetti
Varnavas Varnavas
Muryo Terasawa
Gaetano Paparella
Lucio Capulzini
Riccardo Maj
Yves De Greef
Pedro Brugada
Carlo de Asmundis
Gian-Battista Chierchia
Publication date: 01-08-2019
Publisher: Springer US
Keyword: Atrial Fibrillation
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 2/2019
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-019-00523-0

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of the luminal esophageal temperature behavior during left atrium posterior wall ablation by means of second-generation cryoballoon

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2019

Association between the use of contact force-sensing catheters and cardiac tamponade in atrial fibrillation ablation

Ventricular tachycardia sensitive to antitachycardia pacing in a patient with severely symptomatic Brugada syndrome

Identification of precise accessory pathway using ultra-high-resolution three-dimensional mapping system: utility and feasibility in preliminary experience

Catheter ablation for failed surgical maze: comparison of cut and sew vs. non-cut and sew maze

Physicians’ exposure to radiation during electrophysiology procedures

Viewpoint: Cardiac implantable electronic devices and magnetic resonance compatibility: was it really necessary?

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page