Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation

Purpose The development of an atrio-esophageal fistula, a rare yet potentially lethal complication of ablation for atrial fibrillation, could be related to direct tissue heat transfer during and immediately after the ablation. We therefore studied the postoperative esophageal findings by esophagogas...

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Autores principales:	Rani Kronenberger, Ines Van Loo, Carlo de Asmundis, Maridi Aerts, Sandro Gelsomino, Vincent Umbrain, Gian-Battista Chierchia, Mark La Meir
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	atrial fibrillation ablation atrio-esophageal fistula hybrid ablation esophageal thermal lesions esophagogastroduodenoscopy radiofrequency Medicine R
Acceso en línea:	https://doaj.org/article/a5e72078a2a54e5f90d27d57a69aab0a
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spelling	oai:doaj.org-article:a5e72078a2a54e5f90d27d57a69aab0a2021-11-11T17:36:44ZEsophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation10.3390/jcm102149812077-0383https://doaj.org/article/a5e72078a2a54e5f90d27d57a69aab0a2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4981https://doaj.org/toc/2077-0383Purpose The development of an atrio-esophageal fistula, a rare yet potentially lethal complication of ablation for atrial fibrillation, could be related to direct tissue heat transfer during and immediately after the ablation. We therefore studied the postoperative esophageal findings by esophagogastroduodenoscopy in patients that underwent a hybrid ablation procedure using a novel preventive strategy to avoid thermal lesions. Methods Thirty-four patients (28 males; 65 years ± 9 years) were retrospectively included. All underwent a hybrid ablation in our center between April 2015 and November 2019 and agreed to an esophagogastroduodenoscopy within 0–14 days (mean: 5 days) following the ablation. To reduce the incidence of thermal lesions three procedural preventive strategies were introduced: (i) videoscopic intrathoracic transesophageal echocardiographic probe visualization to understand the relationship between posterior left atrial wall and esophagus, with probe retraction before ablation; (ii) lifting the cardiac tissue away from the esophagus during energy application; and (iii) a 30-s cool-off period after energy delivery with irrigation of the device, the ablated tissue, and the surrounding tissues. Results No esophageal thermal lesions were observed. One third of patients were diagnosed with incidental esophageal findings unrelated to the ablation procedure (11; 32.4%). Conclusion Novel preventive strategies by visualization and by avoiding contact between the ablation catheter or ablated tissue and the pericardium, seems to eliminate the potential risk of esophageal thermal lesions in the setting of hybrid ablation. Since one third of patients had preexisting esophageal disease, a more comprehensive pre-operative screening could be important to reduce the risk.Rani KronenbergerInes Van LooCarlo de AsmundisMaridi AertsSandro GelsominoVincent UmbrainGian-Battista ChierchiaMark La MeirMDPI AGarticleatrial fibrillation ablationatrio-esophageal fistulahybrid ablationesophageal thermal lesionsesophagogastroduodenoscopyradiofrequencyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4981, p 4981 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation ablation atrio-esophageal fistula hybrid ablation esophageal thermal lesions esophagogastroduodenoscopy radiofrequency Medicine R
spellingShingle	atrial fibrillation ablation atrio-esophageal fistula hybrid ablation esophageal thermal lesions esophagogastroduodenoscopy radiofrequency Medicine R Rani Kronenberger Ines Van Loo Carlo de Asmundis Maridi Aerts Sandro Gelsomino Vincent Umbrain Gian-Battista Chierchia Mark La Meir Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
description	Purpose The development of an atrio-esophageal fistula, a rare yet potentially lethal complication of ablation for atrial fibrillation, could be related to direct tissue heat transfer during and immediately after the ablation. We therefore studied the postoperative esophageal findings by esophagogastroduodenoscopy in patients that underwent a hybrid ablation procedure using a novel preventive strategy to avoid thermal lesions. Methods Thirty-four patients (28 males; 65 years ± 9 years) were retrospectively included. All underwent a hybrid ablation in our center between April 2015 and November 2019 and agreed to an esophagogastroduodenoscopy within 0–14 days (mean: 5 days) following the ablation. To reduce the incidence of thermal lesions three procedural preventive strategies were introduced: (i) videoscopic intrathoracic transesophageal echocardiographic probe visualization to understand the relationship between posterior left atrial wall and esophagus, with probe retraction before ablation; (ii) lifting the cardiac tissue away from the esophagus during energy application; and (iii) a 30-s cool-off period after energy delivery with irrigation of the device, the ablated tissue, and the surrounding tissues. Results No esophageal thermal lesions were observed. One third of patients were diagnosed with incidental esophageal findings unrelated to the ablation procedure (11; 32.4%). Conclusion Novel preventive strategies by visualization and by avoiding contact between the ablation catheter or ablated tissue and the pericardium, seems to eliminate the potential risk of esophageal thermal lesions in the setting of hybrid ablation. Since one third of patients had preexisting esophageal disease, a more comprehensive pre-operative screening could be important to reduce the risk.
format	article
author	Rani Kronenberger Ines Van Loo Carlo de Asmundis Maridi Aerts Sandro Gelsomino Vincent Umbrain Gian-Battista Chierchia Mark La Meir
author_facet	Rani Kronenberger Ines Van Loo Carlo de Asmundis Maridi Aerts Sandro Gelsomino Vincent Umbrain Gian-Battista Chierchia Mark La Meir
author_sort	Rani Kronenberger
title	Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
title_short	Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
title_full	Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
title_fullStr	Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
title_full_unstemmed	Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation
title_sort	esophageal findings in the setting of a novel preventive strategy to avoid thermal lesions during hybrid thoracoscopic radiofrequency ablation for atrial fibrillation
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/a5e72078a2a54e5f90d27d57a69aab0a
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Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation

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