Esophageal cooling for protection during left atrial ablation : a systematic review and meta-analysis
Leung, Lisa W. M. (St George's University Hospitals NHS Foundation Trust, St. George's, University of London. Department of Cardiology)
Gallagher, Mark M. (St George's University Hospitals NHS Foundation Trust, St. George's, University of London. Department of Cardiology)
Santangeli, Pasquale (University of Pennsylvania. Perelman School of Medicine)
Tschabrunn, Cory (University of Pennsylvania. Perelman School of Medicine)
Guerra Ramos, José María (Institut d'Investigació Biomèdica Sant Pau)
Campos, Bieito (Institut d'Investigació Biomèdica Sant Pau)
Hayat, Jamal (St George's University Hospitals NHS Foundation Trust, St. George's, University of London. Department of Gastroenterology)
Atem, Folefac (UT Southwestern Medical Center. Department of Neurology and Neurotherapeutics)
Mickelsen, Steven (University of Iowa Carver College of Medicine. Department of Internal Medicine)
Kulstad, Erik (UT Southwestern Medical Center. Department of Emergency Medicine)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0. 6, 95% CI 0. 15 to 2. 38). For high-grade lesions, a significant OR of 0. 39 (95% CI 0. 17 to 0. 89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation. Esophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atrial fibrillation ; Radiofrequency ablation ; Esophageal injury ; Esophageal cooling ; Atrio-esophageal fistula
Publicat a:	Journal of Interventional Cardiac Electrophysiology, Vol. 59 (november 2019) , p. 347-355, ISSN 1572-8595

DOI: 10.1007/s10840-019-00661-5
PMID: 31758504

9 p, 834.9 KB

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