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Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths

BACKGROUND: Left atrial–esophageal fistulas (LAEFs) are serious complications with high mortality after atrial fibrillation radiofrequency ablation (AFRA). Decreasing the incidence of esophageal thermal lesions (EsoTLs) that may lead to LAEFs is important. The aim of this study was to suppress EsoTL...

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Autores principales: Watanabe, Norikazu, Chiba, Yuta, Onishi, Yoshimi, Kawasaki, Shiro, Munetsugu, Yumi, Onuma, Yoshimasa, Itou, Hiroyuki, Onuki, Tatsuya, Minoura, Yoshino, Adachi, Taro, Kawamura, Mitsuharu, Asano, Taku, Tanno, Kaoru, Kubota, Yutarou, Konishi, Kazuo, Kobayashi, Youichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300859/
https://www.ncbi.nlm.nih.gov/pubmed/28217225
http://dx.doi.org/10.1016/j.joa.2016.05.001
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author Watanabe, Norikazu
Chiba, Yuta
Onishi, Yoshimi
Kawasaki, Shiro
Munetsugu, Yumi
Onuma, Yoshimasa
Itou, Hiroyuki
Onuki, Tatsuya
Minoura, Yoshino
Adachi, Taro
Kawamura, Mitsuharu
Asano, Taku
Tanno, Kaoru
Kubota, Yutarou
Konishi, Kazuo
Kobayashi, Youichi
author_facet Watanabe, Norikazu
Chiba, Yuta
Onishi, Yoshimi
Kawasaki, Shiro
Munetsugu, Yumi
Onuma, Yoshimasa
Itou, Hiroyuki
Onuki, Tatsuya
Minoura, Yoshino
Adachi, Taro
Kawamura, Mitsuharu
Asano, Taku
Tanno, Kaoru
Kubota, Yutarou
Konishi, Kazuo
Kobayashi, Youichi
author_sort Watanabe, Norikazu
collection PubMed
description BACKGROUND: Left atrial–esophageal fistulas (LAEFs) are serious complications with high mortality after atrial fibrillation radiofrequency ablation (AFRA). Decreasing the incidence of esophageal thermal lesions (EsoTLs) that may lead to LAEFs is important. The aim of this study was to suppress EsoTL development and determine the appropriate alarm setting for a temperature-monitoring probe by using steerable sheath (STS) methods. METHODS: We enrolled 82 consecutive patients (mean, 61.9±11.7 years; 75.6% men) who underwent AFRA, including pulmonary vein isolation for symptomatic, drug-refractory atrial fibrillation with esophageal temperature monitoring by using STS between January 2011 and April 2014. All patients underwent upper gastrointestinal endoscopy (UGE) 1–3 days after AFRA. The timing of ablation discontinuation in the first 17 patients was determined by each physician during AFRA (only monitoring group, OM). In the next 65 patients, physicians were to immediately discontinue ablation when an alarm set at 39 °C went off (instruction group, INS). We compared two groups with respect to the incidence of EsoTLs. RESULTS: Among the 82 patients, 5 (6.1%) had EsoTLs after AFRA. EsoTLs occurred in 3 of 17 patients (17.6%) and 2 of 65 patients (3.1%) in the OM and INS groups, respectively. The incidence of EsoTLs in the INS group was significantly lower than that in the OM group (p=0.0254). EsoTL did not occur at maximal temperature less than 39 °C, measured by using esophageal temperature-monitoring probe. CONCLUSIONS: Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreased the incidence of EsoTLs, even when using STS.
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spelling pubmed-53008592017-02-17 Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths Watanabe, Norikazu Chiba, Yuta Onishi, Yoshimi Kawasaki, Shiro Munetsugu, Yumi Onuma, Yoshimasa Itou, Hiroyuki Onuki, Tatsuya Minoura, Yoshino Adachi, Taro Kawamura, Mitsuharu Asano, Taku Tanno, Kaoru Kubota, Yutarou Konishi, Kazuo Kobayashi, Youichi J Arrhythm Original Article BACKGROUND: Left atrial–esophageal fistulas (LAEFs) are serious complications with high mortality after atrial fibrillation radiofrequency ablation (AFRA). Decreasing the incidence of esophageal thermal lesions (EsoTLs) that may lead to LAEFs is important. The aim of this study was to suppress EsoTL development and determine the appropriate alarm setting for a temperature-monitoring probe by using steerable sheath (STS) methods. METHODS: We enrolled 82 consecutive patients (mean, 61.9±11.7 years; 75.6% men) who underwent AFRA, including pulmonary vein isolation for symptomatic, drug-refractory atrial fibrillation with esophageal temperature monitoring by using STS between January 2011 and April 2014. All patients underwent upper gastrointestinal endoscopy (UGE) 1–3 days after AFRA. The timing of ablation discontinuation in the first 17 patients was determined by each physician during AFRA (only monitoring group, OM). In the next 65 patients, physicians were to immediately discontinue ablation when an alarm set at 39 °C went off (instruction group, INS). We compared two groups with respect to the incidence of EsoTLs. RESULTS: Among the 82 patients, 5 (6.1%) had EsoTLs after AFRA. EsoTLs occurred in 3 of 17 patients (17.6%) and 2 of 65 patients (3.1%) in the OM and INS groups, respectively. The incidence of EsoTLs in the INS group was significantly lower than that in the OM group (p=0.0254). EsoTL did not occur at maximal temperature less than 39 °C, measured by using esophageal temperature-monitoring probe. CONCLUSIONS: Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreased the incidence of EsoTLs, even when using STS. Elsevier 2017-02 2016-06-03 /pmc/articles/PMC5300859/ /pubmed/28217225 http://dx.doi.org/10.1016/j.joa.2016.05.001 Text en © 2016 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Watanabe, Norikazu
Chiba, Yuta
Onishi, Yoshimi
Kawasaki, Shiro
Munetsugu, Yumi
Onuma, Yoshimasa
Itou, Hiroyuki
Onuki, Tatsuya
Minoura, Yoshino
Adachi, Taro
Kawamura, Mitsuharu
Asano, Taku
Tanno, Kaoru
Kubota, Yutarou
Konishi, Kazuo
Kobayashi, Youichi
Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title_full Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title_fullStr Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title_full_unstemmed Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title_short Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
title_sort immediate discontinuation of ablation during pulmonary vein isolation remarkably decreases the incidence of esophageal thermal lesions even when using steerable sheaths
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300859/
https://www.ncbi.nlm.nih.gov/pubmed/28217225
http://dx.doi.org/10.1016/j.joa.2016.05.001
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