Abstract 16605: The Effectiveness and Safety of the Esophageal Temperature Monitoring During Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Miwa Ito ◽  
Hisanori Kanazawa ◽  
Tadashi Hoshiyama ◽  
Yusei Kawahara ◽  
Kenichi Tsujita
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Characteristic Curve ◽  
Predictive Marker ◽  
Patient Characteristics ◽  
Temperature Monitoring ◽  
Esophageal Injury ◽  
Radiofrequency Energy ◽  
Esophageal Temperature ◽  
Significant Difference

Introduction: Esophageal injury is known to be a serious complication occurs after catheter ablation (CA) of atrial fibrillation (AF). Hypothesis: We investigated the factors associated with the occurrence of EI after CA. Also esophageal temperature monitoring (ETM) can be useful, multiple factors such as patient characteristics and specific strategies for radiofrequency energy delivery also merit consideration. Methods: Among 508 patients who underwent CA of AF, endoscopy was performed the next day after CA to examine for EI. The incidence of EI was compared between 200 patients who done ETM (ETM group) and 308 patients who didn’t done ETM (Non-ETM group) during CA. The Shortest Distance between esophagus and posterior left atrium measured on contrast Computed Tomography (SD-CT) was also compared between both groups. Results: No differences were observed between both groups in total amount of radiofrequency energy applications. However, EI occurred more frequently in Non-ETM group (8/200 patients; 4.0 % vs 27/308 patients; 8.8 %, p=0.042). There was no significant difference in SD-CT between ETM and Non-ETM group. However, SD-CT in patients with EI was significantly shorter than SD-CT in patients without EI, both in ETM (2.4±0.7 vs 4.3±0.9 mm, p<0.001) and in Non-ETM group (2.5±0.2 vs 4.2±0.9 mm, p=0.017), respectively. Multiple regression analysis revealed that only SD-CT significantly correlated with EI. The area under a receiver operating characteristic curve using ST-CT as a predictive marker in EI patients was 0.968 (p<0.001). When the cut-off value of EI was set at 2.9mm, the sensitivity and specificity for EI diagnosis were 96.6% and 87.5%. Conclusions: The use of ETM is absolutely safe and necessary in order to prevent the occurrence of thermal EI.

P1864Primary predictor of esophageal injury after catheter ablation of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ito ◽  
H K Kanazawa ◽  
S K Kaneko ◽  
Y K Kanemaru ◽  
T K Kiyama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Characteristic Curve ◽  
Predictive Marker ◽  
Temperature Monitoring ◽  
Esophageal Injury ◽  
Esophageal Temperature ◽  
Energy Applications ◽  
Significant Difference ◽  
Rf Energy

Abstract Background It has been demonstrated that the short distance between the esophagus and the posterior left atrium (LA) is closely associated with the occurrence of esophageal injury (EI) after catheter ablation of atrial fibrillation (AF). Meanwhile, it has not been fully elucidated whether esophageal temperature monitoring sufficiently prevent EI. Objectives The purpose of this study was to examine the usefulness of esophageal temperature monitoring for avoiding EI. Further we analyzed the relation between the incidence of EI and the distance between the esophagus and the posterior LA measured on the contrast computed tomography (CT). Methods Among 403 patients who underwent catheter ablation of AF, upper gastrointestinal tract endoscopy was performed the next day after ablation to examine for EI. The incidence of EI was compared between 95 patients who used esophageal temperature probe (ETP) (ETP Group) and 308 patients who did not used ETP (Non-ETP Group) during ablation. The shortest distance between esophagus and posterior LA measured on contrast CT (SD-CT) was also compared between the ETP and Non-ETP Groups. Results In all patients, EI was found in 35 patients (8.6%). The SD-CT in patients with EI was significantly lower than that in patients without EI (2.3±0.6 vs 4.1±0.8 mm, p<0.001). No differences were observed between the two groups in terms of age, body mass index, LA diameter, esophageal course, total number of radiofrequency (RF) energy applications, total amount of RF energy applications, or the location of SD-CT. Also, EI occurred at nealy the same frequency between the ETP Group and Non-ETP Group (8/95 patients; 8.4% vs 27/308 patients; 8.8%, p=0.553). The severity diagnosed as moderate (erosion) in 3 patients and mild (erythema) in 5 patients of ETP Group, and as severe (ulcer) in 23 patients and mild (erythema) in 4 patients of Non-ETP Group. There was no significant difference in the SD-CT between the ETP Group and Non-ETP Group (3.96±0.98 vs 4.19±1.01 mm, p=0.54). However, the SD-CT in patients with EI was significantly shorter than the SD-CT in patients without EI, both in the ETP Group (2.3±0.6 vs 4.1±0.9 mm, p<0.001) and in the Non-ETP Group (2.5±0.2 vs 4.2±0.9 mm, p=0.017), respectively. Multiple regression analysis revealed that only SD-CT significantly correlated with EI. The area under a receiver operating characteristic curve using ST-CT as a predictive marker in EI patients was 0.971 (p<0.001). When the cut-off value of EI was set at 2.9mm, the sensitivity and specificity for EI diagnosis were 96.6% and 87.5%. Conclusions The incidence of EI was significantly correlated with SD-CT. Esophageal temperature monitoring did not reduce EI, however, the use of monitoring alleviated the severity of EI, especially in patients with short SD-CT. Acknowledgement/Funding None

Abstract 3231: Esophageal Capsule Endoscopy: Different Findings Based On The Anesthesia Protocol

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Luigi Di Biase ◽  
Stacy Poe ◽  
Luis Carlos Saenz ◽  
Miguel Vacca ◽  
Mauricio Cabrales ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
General Anesthesia ◽  
Capsule Endoscopy ◽  
Conscious Sedation ◽  
Radiofrequency Energy ◽  
List Type ◽  
Esophageal Temperature ◽  
Atrioesophageal Fistula ◽  
Esophageal Capsule

Introduction: Left atrioesophageal fistula is a rare but devastating complication that can occur following catheter ablation of atrial fibrillation. Methods : Fifty patients undergoing AF ablation for paroxysmal and persistent/permanent symptomatic atrial fibrillation refractory to AAD have been enrolled and randomized into 2 groups: those undergoing the procedure under conscious sedation with fentanil or midazolam (25 patients, group and those receiving general anesthesia (25 patients, group All patients underwent esophageal temperature monitoring during the procedure. Radiofrequency energy was discontinued when the luminal temperature reached 39 C. After ablation all patients had capsule endoscopy to assess the presence for endoluminal tissue damage of the esophagus. Results : The results are shown in the table below Conclusion : The use of general anesthesia increases the risk of positive esophageal findings by capsule endoscopy

scholarly journals 16-20: Impact of Contact-Force guided Catheter Ablation for Atrial Fibrillation without usage of Esophageal Temperature Monitoring

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i5-i5
Author(s):  
Christian Blockhaus ◽  
Patrick Müller ◽  
Silke Leonhardt ◽  
Stephan Dahl ◽  
Shqipe Gerguri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Contact Force ◽  
Temperature Monitoring ◽  
Esophageal Temperature

scholarly journals Relationship between serum angiopoietin-like 4 levels and recurrence of atrial fibrillation

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098839
Author(s):  
Zhongping Ning ◽  
Xinming Li ◽  
Xi Zhu ◽  
Jun Luo ◽  
Yingbiao Wu
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Peroxisome Proliferator ◽  
C Reactive Protein ◽  
Peroxisome Proliferator Activated Receptor ◽  
Reactive Protein ◽  
New Onset

Objective To investigate the association between serum angiopoietin-like 4 (ANGPTL4) levels and recurrence of atrial fibrillation (AF) after catheter ablation. Methods This retrospective study recruited patients with AF undergoing catheter ablation and they were divided into two groups (new-onset AF group and recurrent AF group). Demographic, clinical, and laboratory parameters were collected. Results A total of 192 patients with AF were included, including 69 patients with recurrence of AF. Serum ANGPTL4 levels were lower in patients with recurrent AF than in those with new-onset AF. Serum ANGPTL4 levels were positively correlated with superoxide dismutase and peroxisome proliferator-activated receptor γ, and negatively correlated with the CHA2DS2-VASC score, left atrial diameter, and levels of brain natriuretic peptide, malondialdehyde, high-sensitivity C-reactive protein, and interleukin-6. The receiver operating characteristic curve showed that the best cut-off for recurrent AF was serum ANGPTL4 levels  < 19.735 ng/mL, with a sensitivity and specificity of 63.9% and 74.5%, respectively. Serum ANGPTL4 levels were significantly associated with recurrence and new onset of AF (odds ratio, 2.241; 95% confidence interval, 1.081–4.648). Conclusions Serum ANGPTL4 levels are lower in patients with recurrent AF than in those with new-onset AF, and are associated with cardiac hypertrophy, oxidative stress, and inflammation.

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