Advertisement

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

  • 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 ChierchiaEmail author
Article
  • 6 Downloads

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.

Keywords

Luminal esophageal temperature Left atrium posterior wall Esophageal thermal lesion Atrial fibrillation Pulmonary vein isolation 

Notes

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 18.
    Stöckigt F, Schrickel JW, Andrié R, Lickfett L. Atrioesophageal fistula after cryoballoon pulmonary vein isolation. J Cardiovasc Electrophysiol. 2012;23:1254–7.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.Google Scholar
  22. 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.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Thiago Guimarães Osório
    • 1
  • Saverio Iacopino
    • 2
  • Hugo-Enrique Coutiño
    • 1
  • Erwin Ströker
    • 1
  • Juan Sieira
    • 1
  • Francesca Salghetti
    • 1
  • Varnavas Varnavas
    • 1
  • Muryo Terasawa
    • 1
  • Gaetano Paparella
    • 1
  • Lucio Capulzini
    • 1
  • Riccardo Maj
    • 1
  • Yves De Greef
    • 1
  • Pedro Brugada
    • 1
  • Carlo de Asmundis
    • 1
  • Gian-Battista Chierchia
    • 1
    Email author
  1. 1.Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and PacingUniversitair Ziekenhuis Brussel-Vrije Universiteit BrusselBrusselsBelgium
  2. 2.Cardiac Electrophysiology UnitVilla Maria Cecilia Hospital GVMCotignolaItaly

Personalised recommendations