BACKGROUND: Pulmonary vein isolation (PVI) implies unavoidable ablation lesions to the left atrial posterior wall, which is closely related to the esophagus, leading to several potential complications. This study evaluates the usefulness of the esophageal fingerprint in avoiding temperature rises during paroxysmal atrial fibrillation (PAF) ablation. METHODS: Isodistance maps of the atrio-esophageal relationship (esophageal fingerprint) were derived from the preprocedural computerized tomography. Patients were randomized (1:1) into two groups: (1) PRINT group, the PVI line was modified according to the esophageal fingerprint; (2) CONTROL group, standard PVI with operator blinded to the fingerprint. The primary endpoint was temperature rise detected by intraluminal esophageal temperature probe monitoring. Ablation settings were as specified on the Ablate BY-LAW study protocol. RESULTS: Sixty consecutive patients referred for paroxysmal AF ablation were randomized (42 (70%) men, mean age 60 ± 11 years). Temperature rise (> 39.1 °C) occurred in 5 (16%) patients in the PRINT group vs. 17 (56%) in the CONTROL group (p < 0.01). Three AF recurrences were documented at a mean follow-up of 12 ± 3 months (one (3%) in the PRINT group and 2 (6.6%) in the CONTROL group, p = 0.4). CONCLUSION: The esophageal fingerprint allows for a reliable identification of the esophageal position and its use for PVI line deployment results in less frequent esophageal temperature rises when compared to the standard approach. Further studies are needed to evaluate the impact of PVI line modification to avoid esophageal heating on long-term outcomes. The development of new imaging-derived tools could ultimately improve patient safety (NCT04394923).
BACKGROUND: Pulmonary vein isolation (PVI) implies unavoidable ablation lesions to the left atrial posterior wall, which is closely related to the esophagus, leading to several potential complications. This study evaluates the usefulness of the esophageal fingerprint in avoiding temperature rises during paroxysmal atrial fibrillation (PAF) ablation. METHODS: Isodistance maps of the atrio-esophageal relationship (esophageal fingerprint) were derived from the preprocedural computerized tomography. Patients were randomized (1:1) into two groups: (1) PRINT group, the PVI line was modified according to the esophageal fingerprint; (2) CONTROL group, standard PVI with operator blinded to the fingerprint. The primary endpoint was temperature rise detected by intraluminal esophageal temperature probe monitoring. Ablation settings were as specified on the Ablate BY-LAW study protocol. RESULTS: Sixty consecutive patients referred for paroxysmal AF ablation were randomized (42 (70%) men, mean age 60 ± 11 years). Temperature rise (> 39.1 °C) occurred in 5 (16%) patients in the PRINT group vs. 17 (56%) in the CONTROL group (p < 0.01). Three AF recurrences were documented at a mean follow-up of 12 ± 3 months (one (3%) in the PRINT group and 2 (6.6%) in the CONTROL group, p = 0.4). CONCLUSION: The esophageal fingerprint allows for a reliable identification of the esophageal position and its use for PVI line deployment results in less frequent esophageal temperature rises when compared to the standard approach. Further studies are needed to evaluate the impact of PVI line modification to avoid esophageal heating on long-term outcomes. The development of new imaging-derived tools could ultimately improve patient safety (NCT04394923).
Authors: Hans Kottkamp; Christopher Piorkowski; Hildegard Tanner; Richard Kobza; Anja Dorszewski; Petra Schirdewahn; Jin-Hong Gerds-Li; Gerhard Hindricks Journal: J Cardiovasc Electrophysiol Date: 2005-02
Authors: Katharina Schoene; Arash Arya; Friederike Grashoff; Helge Knopp; Alexander Weber; Matthias Lerche; Sebastian König; Sebastian Hilbert; Simon Kircher; Livio Bertagnolli; Borislav Dinov; Gerhard Hindricks; Ulrich Halm; Markus Zachäus; Philipp Sommer Journal: Europace Date: 2020-10-01 Impact factor: 5.214
Authors: Paulus Kirchhof; A John Camm; Andreas Goette; Axel Brandes; Lars Eckardt; Arif Elvan; Thomas Fetsch; Isabelle C van Gelder; Doreen Haase; Laurent M Haegeli; Frank Hamann; Hein Heidbüchel; Gerhard Hindricks; Josef Kautzner; Karl-Heinz Kuck; Lluis Mont; G Andre Ng; Jerzy Rekosz; Norbert Schoen; Ulrich Schotten; Anna Suling; Jens Taggeselle; Sakis Themistoclakis; Eik Vettorazzi; Panos Vardas; Karl Wegscheider; Stephan Willems; Harry J G M Crijns; Günter Breithardt Journal: N Engl J Med Date: 2020-08-29 Impact factor: 91.245
Authors: Derek S Chew; Kelley A Jones; Zak Loring; Eric Black-Maier; Peter A Noseworthy; Derek V Exner; Douglas L Packer; Jennifer Grant; Daniel B Mark; Jonathan P Piccini Journal: Heart Rhythm O2 Date: 2021-11-19