The esophageal effects of cryoenergy during cryoablation for atrial fibrillation

Humera Ahmed, Petr Neuzil, Andre d'Avila, Yong-Mei Cha, Margaret Laragy, Karel Mares, William R. Brugge, David G. Forcione, Jeremy N. Ruskin, Douglas L Packer, Vivek Y. Reddy

Research output: Contribution to journalArticle

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Abstract

Background: Cryoenergy is being increasingly used for atrial fibrillation (AF) ablation, but the thermal effect of cryoenergy on the esophagus remains undefined. Objective: This study examines the esophageal effects of cryoenergy used during AF ablation. Methods: Catheter ablation was performed using a cryoballoon catheter in 67 AF patients (Cryoballoon group), and a spot cryocatheter to complete irrigated radiofrequency lesion sets at segments in close proximity to the esophagus in 7 AF patients (Cryo-Focal group). A temperature probe monitored the luminal esophageal temperature (LET) in all patients; LET changes did not guide therapy. Post-procedural endoscopy was performed on 35 of 67 (52%) Cryoballoon and all Cryo-Focal patients. Results: Significant LET decreases (>1°C) occurred in 62 of 67 (93%) Cryoballoon patients. LET continued to decrease after termination of cryoablation before recovering to normal. Temperature decreases were more pronounced during ablation at the inferior (3.1°C) than superior pulmonary veins (1.5°C); the lowest observed temperature was 0°C. Post-procedural endoscopy showed esophageal ulcerations in 6 of 35 (17%) patients. There were no atrial-esophageal fistulas, and all ulcers had healed on follow-up endoscopy. Patients with and without ulceration differed with respect to mean LET nadir, cumulative LET decrease, and number of LETs <30°C. In the Cryo-Focal group, 6 ± 2 spot cryolesions per patient resulted in 1.3 ± 1 LET decreases per patient, and an absolute nadir of 32.5°C. Conclusion: Cryoballoon ablation can cause significant LET decreases, resulting in reversible esophageal ulcerations in 17% of patients. No ulcerations occurred with adjunctive spot cryoablation at regions near the esophagus during radiofrequency ablation procedures.

Original languageEnglish (US)
Pages (from-to)962-969
Number of pages8
JournalHeart Rhythm
Volume6
Issue number7
DOIs
StatePublished - Jul 2009

Fingerprint

Cryosurgery
Atrial Fibrillation
Temperature
Esophagus
Endoscopy
Esophageal Fistula
Linear Energy Transfer
Catheter Ablation
Pulmonary Veins
Ulcer
Catheters
Hot Temperature

Keywords

  • Arrhythmias
  • Atrial fibrillation
  • Catheter ablation
  • Complications
  • Esophageal injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ahmed, H., Neuzil, P., d'Avila, A., Cha, Y-M., Laragy, M., Mares, K., ... Reddy, V. Y. (2009). The esophageal effects of cryoenergy during cryoablation for atrial fibrillation. Heart Rhythm, 6(7), 962-969. https://doi.org/10.1016/j.hrthm.2009.03.051

The esophageal effects of cryoenergy during cryoablation for atrial fibrillation. / Ahmed, Humera; Neuzil, Petr; d'Avila, Andre; Cha, Yong-Mei; Laragy, Margaret; Mares, Karel; Brugge, William R.; Forcione, David G.; Ruskin, Jeremy N.; Packer, Douglas L; Reddy, Vivek Y.

In: Heart Rhythm, Vol. 6, No. 7, 07.2009, p. 962-969.

Research output: Contribution to journalArticle

Ahmed, H, Neuzil, P, d'Avila, A, Cha, Y-M, Laragy, M, Mares, K, Brugge, WR, Forcione, DG, Ruskin, JN, Packer, DL & Reddy, VY 2009, 'The esophageal effects of cryoenergy during cryoablation for atrial fibrillation', Heart Rhythm, vol. 6, no. 7, pp. 962-969. https://doi.org/10.1016/j.hrthm.2009.03.051
Ahmed, Humera ; Neuzil, Petr ; d'Avila, Andre ; Cha, Yong-Mei ; Laragy, Margaret ; Mares, Karel ; Brugge, William R. ; Forcione, David G. ; Ruskin, Jeremy N. ; Packer, Douglas L ; Reddy, Vivek Y. / The esophageal effects of cryoenergy during cryoablation for atrial fibrillation. In: Heart Rhythm. 2009 ; Vol. 6, No. 7. pp. 962-969.
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abstract = "Background: Cryoenergy is being increasingly used for atrial fibrillation (AF) ablation, but the thermal effect of cryoenergy on the esophagus remains undefined. Objective: This study examines the esophageal effects of cryoenergy used during AF ablation. Methods: Catheter ablation was performed using a cryoballoon catheter in 67 AF patients (Cryoballoon group), and a spot cryocatheter to complete irrigated radiofrequency lesion sets at segments in close proximity to the esophagus in 7 AF patients (Cryo-Focal group). A temperature probe monitored the luminal esophageal temperature (LET) in all patients; LET changes did not guide therapy. Post-procedural endoscopy was performed on 35 of 67 (52{\%}) Cryoballoon and all Cryo-Focal patients. Results: Significant LET decreases (>1°C) occurred in 62 of 67 (93{\%}) Cryoballoon patients. LET continued to decrease after termination of cryoablation before recovering to normal. Temperature decreases were more pronounced during ablation at the inferior (3.1°C) than superior pulmonary veins (1.5°C); the lowest observed temperature was 0°C. Post-procedural endoscopy showed esophageal ulcerations in 6 of 35 (17{\%}) patients. There were no atrial-esophageal fistulas, and all ulcers had healed on follow-up endoscopy. Patients with and without ulceration differed with respect to mean LET nadir, cumulative LET decrease, and number of LETs <30°C. In the Cryo-Focal group, 6 ± 2 spot cryolesions per patient resulted in 1.3 ± 1 LET decreases per patient, and an absolute nadir of 32.5°C. Conclusion: Cryoballoon ablation can cause significant LET decreases, resulting in reversible esophageal ulcerations in 17{\%} of patients. No ulcerations occurred with adjunctive spot cryoablation at regions near the esophagus during radiofrequency ablation procedures.",
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AU - Laragy, Margaret

AU - Mares, Karel

AU - Brugge, William R.

AU - Forcione, David G.

AU - Ruskin, Jeremy N.

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N2 - Background: Cryoenergy is being increasingly used for atrial fibrillation (AF) ablation, but the thermal effect of cryoenergy on the esophagus remains undefined. Objective: This study examines the esophageal effects of cryoenergy used during AF ablation. Methods: Catheter ablation was performed using a cryoballoon catheter in 67 AF patients (Cryoballoon group), and a spot cryocatheter to complete irrigated radiofrequency lesion sets at segments in close proximity to the esophagus in 7 AF patients (Cryo-Focal group). A temperature probe monitored the luminal esophageal temperature (LET) in all patients; LET changes did not guide therapy. Post-procedural endoscopy was performed on 35 of 67 (52%) Cryoballoon and all Cryo-Focal patients. Results: Significant LET decreases (>1°C) occurred in 62 of 67 (93%) Cryoballoon patients. LET continued to decrease after termination of cryoablation before recovering to normal. Temperature decreases were more pronounced during ablation at the inferior (3.1°C) than superior pulmonary veins (1.5°C); the lowest observed temperature was 0°C. Post-procedural endoscopy showed esophageal ulcerations in 6 of 35 (17%) patients. There were no atrial-esophageal fistulas, and all ulcers had healed on follow-up endoscopy. Patients with and without ulceration differed with respect to mean LET nadir, cumulative LET decrease, and number of LETs <30°C. In the Cryo-Focal group, 6 ± 2 spot cryolesions per patient resulted in 1.3 ± 1 LET decreases per patient, and an absolute nadir of 32.5°C. Conclusion: Cryoballoon ablation can cause significant LET decreases, resulting in reversible esophageal ulcerations in 17% of patients. No ulcerations occurred with adjunctive spot cryoablation at regions near the esophagus during radiofrequency ablation procedures.

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KW - Arrhythmias

KW - Atrial fibrillation

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KW - Complications

KW - Esophageal injury

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