scholarly journals Esophageal Cooling For Protection During Left Atrial Ablation: A Systematic Review And Meta- Analysis

2019 ◽  
Author(s):  
Lisa Leung ◽  
Mark Gallagher ◽  
Pasquale Santangeli ◽  
Cory Tschabrunn ◽  
Jose Guerra ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Cold Water ◽  
Meta Analysis ◽  
Extraction Methods ◽  
Heat Extraction ◽  
Esophageal Injury ◽  
Rf Ablation ◽  
Model Studies ◽  
Atrial Ablation ◽  
Lesion Severity

ABSTRACTBackgroundThermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF), with the most extreme type of thermal injury resulting in atrio-esophageal fistula (AEF), with a correspondingly high mortality rate. Various approaches have been developed to reduce esophageal injury, including power reduction, avoidance of greater contact-force, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit.ObjectiveWe sought to perform a meta-analysis of existing studies evaluating esophageal cooling via direct liquid instillation for the reduction of thermal injury.MethodsWe reviewed Medline for existing studies involving esophageal cooling for protection of thermal injury during RF ablation. A meta-analysis was then performed using random effects model to calculate estimated effect size with 95% confidence intervals, with outcome of esophageal lesions, stratified by severity, as determined by post-procedure endoscopy.ResultsA total of 9 studies were identified and reviewed. After excluding pre-clinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even utilizing a low-capacity thermal extraction technique, reduces lesion severity from RF ablation.ConclusionsEsophageal cooling reduces lesion severity encountered during RF ablation, even when using relatively low heat extraction methods such as direct instillation of cold liquid. Further investigation of this approach is warranted.

scholarly journals Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis

2019 ◽  
Vol 59 (2) ◽  
pp. 347-355 ◽  
Author(s):  
Lisa WM Leung ◽  
Mark M Gallagher ◽  
Pasquale Santangeli ◽  
Cory Tschabrunn ◽  
Jose M Guerra ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Cold Water ◽  
Meta Analysis ◽  
Extraction Methods ◽  
Heat Extraction ◽  
Esophageal Injury ◽  
Rf Ablation ◽  
Extraction Capacity ◽  
Model Studies ◽  
Atrial Ablation

Abstract Purpose Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. Methods We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. Results A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation. Conclusions Esophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.

P1379Fluoroscopy requirement reduction using an esophageal cooling protocol during left atrial ablation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Zagrodzky ◽  
S Bailey ◽  
S Shah ◽  
E Kulstad
Keyword(s):  
Fluoroscopy Time ◽  
Esophageal Injury ◽  
Rf Ablation ◽  
Cooling Device ◽  
Atrial Ablation ◽  
Single Sensor ◽  
The Difference ◽  
Sensor Temperature ◽  
Time Required ◽  
Cold Liquid

Abstract Background Ablation of the left atrium with radiofrequency (RF) energy is associated with some risks to the esophagus.  Cooling the esophagus has been used as one approach to reducing esophageal injury, most commonly with direct instillation of cold liquid via gastric tube placed in the esophagus.  A new esophageal cooling device avoids the risks of free liquid instillation by using a closed-loop system, and avoids the need for frequent repositioning or stopping of the procedure often required when utilizing luminal esophageal temperature (LET) monitoring.  This in turn may reduce fluoroscopy requirements for the procedure. Purpose Measure the difference in fluoroscopy time required during RF ablation using an esophageal cooling device protocol, and compare this to standard LET monitoring using single or multi-sensor temperature probes. Methods We obtained total fluoroscopy time per patient from records of RF ablation procedures performed by a two operators over a 12 month period.  We compared fluoroscopy times between patients treated with an esophageal cooling device to control patients who were treated with LET monitoring using either single-sensor or multi-sensor temperature probes. Results Fluoroscopy times were available for a total of 179 patients treated with an esophageal cooling device, and 118 patients treated with LET monitoring over the 12 month study period.  Mean fluoroscopy time for patients treated with esophageal cooling was 4.0 minutes (SD 4.9 minutes) with a median of 2.0 minutes (IQR 1.3 to 3.8 minutes).  Mean fluoroscopy time for patients undergoing LET monitoring was 5.5 minutes (SD 5.7 minutes) with a median of 3.0 minutes (IQR 1.9 to 8.4 minutes).  This difference represents a 27% reduction in mean fluoroscopy time, and a 33% reduction in median fluoroscopy time in the esophageal cooling group (p<.001, Mann-Whitney U test). Conclusions  Fluoroscopy requirements were reduced by 27% with an esophageal cooling device when compared to standard LET monitoring.

scholarly journals Infographic: Fifteen years of Brazilian Journal of Motor Behavior

2021 ◽  
Vol 15 (5) ◽  
pp. 287-288
Author(s):  
Fabio A. Barbieri ◽  
José A. Barela ◽  
Natália M. Rinaldi
Keyword(s):  
Open Access ◽  
Latin American ◽  
Motor Behavior ◽  
Meta Analysis ◽  
Open Access Journal ◽  
Current Opinion ◽  
Visual Material ◽  
Model Studies ◽  
Self Instruction ◽  
Brazilian Journal

The Brazilian Journal of Motor Behavior (BJMB) is a quadriannual, peer-reviewed, free of charge/fee and open-access journal published by the Brazilian Society of Motor Behavior (SOCIBRACOM). The BJMB has published original contributions within the multidisciplinary study of human motor behavior, in the broad scope of motor control, development and learning, movement disorders, sports, clinical, theoretical and model studies. Since 2019 the BJMBpublishes manuscripts only in English. In the same year, BJMB started to invite researchers to be guest editors in article collections, providing an excellent opportunity to promote high-quality contents within the field. The BJMB is the main motor behavior journal in the Latin American. It is widely recognized for its significant academic contribution and indexed in the UlrichsWeb Global Serial Directory, Diadorium, Gale Directory Library, Google Scholar, Road Directory of Open Access Scholary resources and Red Iberoamericana de Innovación y Conocimiento Científico. The number of edition and papers has sustainable and significantly increased in the last years, with over 500 authors contributing with 121 manuscripts, distributed in 40 numbers. The time of peer-reviewed process is short (first revision- 26 days) and paper publication is quick (57 days). The BJMB was launched with its first edition published in December of 2006 and, thus, we are celebrating its 15thanniversary. For that, the BJMB launches a new type of manuscript: INFOGRAPHIC. This initiative aims to provide a quick, easy-to-use and enjoyable publication that conveys notable knowledge. Two types of infographics will be publishable: a) theory perspective: visual material to theory acknowledge to facilitate the understanding of models, theory frameworks, concepts, principles, and approaches in the field; b) article infographic: visual material about interventional effects on motor learning, development and control sustained by reviews and/or meta-analysis. The infographic section will be added to those already existing: research, systematic review and meta-analysis, mini review, scoping review, research notes, current opinion, critique, and tutorials. It is interesting to highlight the section about tutorial, which emphasizes and provides reflection on the use of one or several methods or self-instruction in motor behavior. Finally, the current opinion section publishes pieces of diverse authors around the world that provide perspectives on a hot, relevant, and perhaps controversial topic within the scope of BJMB. We would like to congratulate all for this important occasion and to wish that the BJMB continues publishing impactful and relevant contributions in the motor behavior field still for many years to come.

scholarly journals Systematic Review and Meta-Analysis of Interventions to Slow Progression of Abdominal Aortic Aneurysm in Mouse Models

2021 ◽  
Author(s):  
James Phie ◽  
Shivshankar Thanigaimani ◽  
Jonathan Golledge
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Mouse Models ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Model Studies ◽  
Abdominal Aortic ◽  
Meta Analyses

Objective: There are no current effective abdominal aortic aneurysm (AAA) drug therapies. An important limitation of most preclinical studies is that they test the effect of drugs on AAA formation rather than AAA progression. The aim of this study was to systematically review AAA mouse model studies that have tested the effect of interventions in limiting the progression of preestablished AAA. Approach and Results: The literature search identified 35 studies meeting eligibility, and 30 (n=935 mice) contributed to the meta-analyses. AAAs were induced with angiotensin II (n=745 mice), calcium chloride (n=91 mice), or elastase (n=99 mice). Anti-inflammatory drugs (standardized mean difference [SMD], 1.62 [95% CI, 0.93–2.30]), protease inhibitors (SMD, 1.23 [95% CI, 0.52–1.95]), stem cells (SMD, 1.64 [95% CI, 1.05–2.24]), antiplatelet or anticoagulant drugs (SMD, 0.93 [95% CI, 0.63–1.22]), and renin-angiotensin system inhibitors (SMD, 1.45 [95% CI, 0.58–2.33]) reduced AAA diameter. Interventions initiated soon after model induction commenced were more likely to reduce AAA diameter (R 2 , 16%; P =0.007). Funnel plots suggested possible publication bias. Most studies did not report blinding or sample size calculations, and the risk of bias was considered medium or high in 20 (57%) of the 35 studies. Conclusions: There is low-quality evidence that a range of drugs are effective in limiting AAA progression when administered early after AAA induction in mouse models. Some of these drugs, such as antiplatelet and renin-angiotensin system inhibitors, have been reported to be ineffective in clinical trials.

Abstract 12970: High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chol Techorueangwiwat ◽  
Chanavuth Kanitsoraphan ◽  
Thiratest Leesutipornchai ◽  
Wasawat Vutthikraivit ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Power ◽  
High Power ◽  
Injury Risk ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Esophageal Injury ◽  
Procedure Time ◽  
Case Control Studies ◽  
Large Populations

Background: Although high power, shorter duration (HPSD) ablation and low power, longer duration (LPLD) ablation strategies for atrial fibrillation (AF) are frequently advocated to enhance safety and efficacy, there exists a need for comparative data from large populations. We performed a meta-analysis to compare arrhythmia-free survival, procedure time and complications rates between the two strategies. Methods: We searched the databases of MEDLINE and EMBASE from inception to April 2020. Included studies were case-control studies, cohort studies, or randomized controlled trials that compared patients undergoing HPSD and LPLD strategies for AF ablation and reported either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. Data from each study were combined using the random-effects model to calculate odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI). Results: Ten studies from 2006 to 2020 involving 2,189 patients were included (1,350 patients underwent HPSD strategy and 839 patients underwent LPLD strategy). Both HPSD and LPLD strategies resulted in a similar freedom from AT at 12-month follow-up (OR=1.36, 95% CI:0.91-2.04, p=0.13, Figure 1A). HPSD strategy did result in a significant reduction in total procedure time (WMD=47.34, 95% CI:29.47-65.21, p<0.001, Figure 1B) compared to LPSD. HPSD wasn’t associated with reduction in esophageal ulcer/arterioesophageal fistula (OR=0.35, 95%CI=0.12-1.06, p=0.06) or pericardial effusion/cardiac tamponade (OR=0.96, 95%CI: 0.24-3.79, p=0.95) Conclusions: In this large meta-analysis both LPLD and HPSD are equally effective and safe. Although HPSD is often advocated to reduce esophageal injury, risk was similar between approaches. However, HPSD strategy significantly lowers procedure times.

Moving away from esophageal injury during left atrial ablation

Heart Rhythm ◽  
2009 ◽  
Vol 6 (3) ◽  
pp. 323-324 ◽  
Author(s):  
T. Jared Bunch ◽  
John D. Day
Keyword(s):  
Left Atrial ◽  
Esophageal Injury ◽  
Atrial Ablation

P1861Influence of thermal conductivity on esophageal protection with a cooling device during high-power short-duration radiofrequency ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Kulstad ◽  
M Mercado-Montoya ◽  
S Shah
Keyword(s):  
Thermal Conductivity ◽  
Short Duration ◽  
High Power ◽  
Operating Conditions ◽  
Whole Body ◽  
Esophageal Injury ◽  
Cooling Power ◽  
Protective Effects ◽  
Rf Ablation ◽  
Cooling Device

Abstract Introduction Recent clinical data show that high-power, short-duration (HPSD) radiofrequency (RF) ablation can result in a similar esophageal injury rate as traditional low-power, long-duration (LPLD) ablation. Existing methods to prevent esophageal injury have yielded mixed results and can result in prolonged procedure time, potentially increasing the incidence of post-operative cognitive dysfunction. A new esophageal cooling device currently available for whole-body temperature modulation is being studied for the prevention of esophageal injury during LPLD RF ablation and cryoablation. We sought to develop a mathematical model of HPSD ablation in order to quantify the capability of this new esophageal cooling device to protect from esophageal injury under high-power conditions. Methods Using a model we developed of HPSD RF ablation in the left atrium, we measured the change in esophageal lesion formation and the depth of lesions (measured as percent transmurality) with the esophageal cooling device in place and operating at a temperature from 5°C to 37°C. Tissue parameters, including thermal conductivity, were set to average values obtained from existing literature, and energy settings were evaluated at 50W for between 5 and 10 seconds, and at 90W for a duration of 4 seconds. Results Esophageal injury as measured by percent transmurality was considerably higher at 50W and 10s duration than at 90W of power with 4s duration, although both settings showed potential for esophageal injury. The protective effect of the esophageal cooling device was evident for both cases, with a greater effect when using 50W for 10s (Figure 1). At the coldest device settings, using a 5 min pre-cooling period also reduced the transmurality of the intended atrial lesions. Esophageal protection in HPSD ablation Conclusions Esophageal cooling with a new patient temperature management device shows protective effects against thermal injury during RF ablation across a range of tissue thermal conductivity, using a variety of high-power settings, including 90W applied for 4 seconds. Adjusting the cooling power by adjusting the circulating water temperature in the device allows for a tailoring of the protective effects to operating conditions. Acknowledgement/Funding Attune Medical

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