Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation.
Atrial fibrillation
Esophageal cooling
Esophageal protection
Procedural efficacy
Pulmonary vein isolation
Radiofrequency ablation
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
20
10
2022
accepted:
10
01
2023
medline:
4
10
2023
pubmed:
21
1
2023
entrez:
20
1
2023
Statut:
ppublish
Résumé
Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation. Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) and those treated with traditional LET monitoring using Kaplan-Meier estimates. A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes; and 260 received active cooling. The mean age was 66.8 (SD ± 10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045). In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
Sections du résumé
BACKGROUND
BACKGROUND
Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation.
METHOD
METHODS
Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) and those treated with traditional LET monitoring using Kaplan-Meier estimates.
RESULTS
RESULTS
A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes; and 260 received active cooling. The mean age was 66.8 (SD ± 10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045).
CONCLUSIONS
CONCLUSIONS
In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
Identifiants
pubmed: 36670327
doi: 10.1007/s10840-023-01474-3
pii: 10.1007/s10840-023-01474-3
pmc: PMC10359433
mid: NIHMS1901149
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1621-1629Subventions
Organisme : NHLBI NIH HHS
ID : R44 HL158375
Pays : United States
Organisme : NHLBI NIH HHS
ID : R44HL158375
Pays : United States
Organisme : NHLBI NIH HHS
ID : R44HL158375
Pays : United States
Informations de copyright
© 2023. The Author(s).
Références
Della Rocca DG, Magnocavallo M, Natale VN, Gianni C, Mohanty S, Trivedi C, Lavalle C, Forleo GB, Tarantino N, Romero J, et al. Clinical presentation, diagnosis, and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2021;32(9):2441–50. https://doi.org/10.1111/jce.15168 .
doi: 10.1111/jce.15168
pubmed: 34260115
Halbfass P, Pavlov B, Muller P, Nentwich K, Sonne K, Barth S, Hamm K, Fochler F, Mugge A, Lusebrink U, et al. Progression from esophageal thermal asymptomatic lesion to perforation complicating atrial fibrillation ablation: a single-center registry. Circ Arrhythm Electrophysiol. 2017:10(8). https://doi.org/10.1161/circep.117.005233
Leung LWM, Akhtar Z, Sheppard MN, Louis-Auguste J, Hayat J, Gallagher MM. Preventing esophageal complications from atrial fibrillation ablation: a review 02. Heart Rhythm. 2021;2(6):651–64. https://doi.org/10.1016/j.hroo.2021.09.004 .
doi: 10.1016/j.hroo.2021.09.004
Schoene K, Arya A, Grashoff F, Knopp H, Weber A, Lerche M, König S, Hilbert S, Kircher S, Bertagnolli L, et al. Oesophageal probe evaluation in radiofrequency ablation of atrial fibrillation (OPERA): results from a prospective randomized trial. Europace. 2020;22(10):1487–94. https://doi.org/10.1093/europace/euaa209 .
doi: 10.1093/europace/euaa209
pubmed: 32820324
Meininghaus DG, Blembel K, Waniek C, Kruells-Muench J, Ernst H, Kleemann T, Geller JC: Temperature monitoring and temperature-driven irrigated radiofrequency energy titration do not prevent thermally-induced esophageal lesions in pulmonary vein isolation a randomized study controlled by esophagoscopy before and after catheter ablation. Heart Rhythm. 2021 https://doi.org/10.1016/j.hrthm.2021.02.003
Berjano EJ, Hornero F. A cooled intraesophageal balloon to prevent thermal injury during endocardial surgical radiofrequency ablation of the left atrium: a finite element study. Phys Med Biol. 2005;50(20):N269-279. https://doi.org/10.1088/0031-9155/50/20/N03 .
doi: 10.1088/0031-9155/50/20/N03
pubmed: 16204868
Leung LW, Gallagher MM, Santangeli P, Tschabrunn C, Guerra JM, Campos B, Hayat J, Atem F, Mickelsen S, Kulstad E: Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2019. https://doi.org/10.1007/s10840-019-00661-5
Leung LWM, Bajpai A, Zuberi Z, Li A, Norman M, Kaba RA, Akhtar Z, Evranos B, Gonna H, Harding I, et al. Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT study. Europace. 2021;23(2):205–15. https://doi.org/10.1093/europace/euaa276 .
doi: 10.1093/europace/euaa276
pubmed: 33205201
Tschabrunn CM, Attalla S, Salas J, Frankel DS, Hyman MC, Simon E, Sharkoski T, Callans DJ, Supple GE, Nazarian S, et al. Active esophageal cooling for the prevention of thermal injury during atrial fibrillation ablation: a randomized controlled pilot study. J Interv Card Electrophysiol. 2022;63(1):197–205. https://doi.org/10.1007/s10840-021-00960-w .
doi: 10.1007/s10840-021-00960-w
pubmed: 33620619
Joseph C, Sherman J, Ro A, Fisher WG, Nazari J, Metzl M: Procedural time reduction associated with active esophageal cooling during pulmonary vein isolation. J Interv Card Electrophysiol. 2022. https://doi.org/10.1007/s10840-022-01204-1
Zagrodzky J, Bailey S, Shah S, Kulstad E. Impact of active esophageal cooling on fluoroscopy usage during left atrial ablation. J Innov Card Rhythm Manag. 2021;12(11):4749–55. https://doi.org/10.19102/icrm.2021.121101 .
doi: 10.19102/icrm.2021.121101
pubmed: 34676132
pmcid: 8519316
Montoya MM, Mickelsen S, Clark B, Arnold M, Hanks J, Sauter E, Kulstad E. Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device. J Atrial Fibrillation. 2019;11(5):2110. https://doi.org/10.4022/jafib.2110 .
doi: 10.4022/jafib.2110
Mercado M, Leung L, Gallagher M, Shah S, Kulstad E. Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions. Biomed Eng Online. 2020;19(1):77. https://doi.org/10.1186/s12938-020-00821-z .
doi: 10.1186/s12938-020-00821-z
pubmed: 33046057
pmcid: 7552446
Wm Leung L, Akhtar Z, A IE, Bajpai A, Li A, Norman M, Kaba R, Sohal M, Zuberi Z, Gallagher MM: Effect of esophageal cooling on ablation lesion formation in the left atrium: insights from ablation index data in the IMPACT trial and clinical outcomes. J Cardiovasc Electrophysiol. 2022. https://doi.org/10.1111/jce.15717
Jankelson L, Dai M, Aizer A, Bernstein S, Park DS, Holmes D, Chinitz LA, Barbhaiya C. Lesion sequence and catheter spatial stability affect lesion quality markers in atrial fibrillation ablation. JACC Clinical Electrophysiol. 2021;7(3):367–77. https://doi.org/10.1016/j.jacep.2020.09.027 .
doi: 10.1016/j.jacep.2020.09.027
Kautzner J, Neuzil P, Lambert H, Peichl P, Petru J, Cihak R, Skoda J, Wichterle D, Wissner E, Yulzari A, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015;17(8):1229–35. https://doi.org/10.1093/europace/euv057 .
doi: 10.1093/europace/euv057
pubmed: 26041872
pmcid: 4535556
Steiger N, Qian PC, Foley G, Bomma T, Kreidieh O, Whitaker J, Thurber CJ, Koplan BA, Tadros TM, Kapur S, et al. Measured temperatures using uninterrupted and interrupted sequences of radiofrequency applications in a phantom gel model: implications for esophageal injury. J Interv Card Electrophysiol. 2022. https://doi.org/10.1007/s10840-022-01373-z
Hernán MA, Brumback B, Robins JM. Marginal structural models to estimate the joint causal effect of nonrandomized treatments. J Am Stat Assoc. 2001;96(454):440–8. https://doi.org/10.1198/016214501753168154PMID .
doi: 10.1198/016214501753168154PMID
Wang L, Nielsen K, Goldberg J, Brown JR, Rumsfeld JS, Steinberg BA, Zhang Y, Matheny ME, Shah RU. Association of wearable device use with pulse rate and health care use in adults with atrial fibrillation. JAMA Netw Open. 2021;4(5):e215821–e215821. https://doi.org/10.1001/jamanetworkopen.2021.5821 .
doi: 10.1001/jamanetworkopen.2021.5821
pubmed: 34042996
pmcid: 8160588
Wan EY, Ghanbari H, Akoum N, Itzhak Attia Z, Asirvatham SJ, Chung EH, Dagher L, Al-Khatib SM, Stuart Mendenhall G, McManus DD, et al. HRS white paper on clinical utilization of digital health technology. Cardiovasc Digit Health J. 2021;2(4):196–211. https://doi.org/10.1016/j.cvdhj.2021.07.001 .
doi: 10.1016/j.cvdhj.2021.07.001
pubmed: 35265910
pmcid: 8890053
Wang YC, Xu X, Hajra A, Apple S, Kharawala A, Duarte G, Liaqat W, Fu Y, Li W, Chen Y, et al Current advancement in diagnosing atrial fibrillation by utilizing wearable devices and artificial intelligence: a review study. Diagnostics (Basel). 2022;12(3). https://doi.org/10.3390/diagnostics12030689
Barbhaiya CR, Kogan EV, Jankelson L, Knotts RJ, Spinelli M, Bernstein S, Park D, Aizer A, Chinitz LA, Holmes D. Esophageal temperature dynamics during high-power short-duration posterior wall ablation. Heart Rhythm. 2020;17(5):721–7. https://doi.org/10.1016/j.hrthm.2020.01.014PMID:31978595 .
doi: 10.1016/j.hrthm.2020.01.014PMID:31978595
pubmed: 31978595
Lardo AC, McVeigh ER, Jumrussirikul P, Berger RD, Calkins H, Lima J, Halperin HR. Visualization and temporal/spatial characterization of cardiac radiofrequency ablation lesions using magnetic resonance imaging. Circ. 2000;102(6):698–705. https://doi.org/10.1161/01.cir.102.6.698 .
doi: 10.1161/01.cir.102.6.698
Weerasooriya R, Jaïs P, Sanders P, Scavée C, Hsu LF, Hocini M, Clementy J, Haïssaguerre M. Images in cardiovascular medicine. Early appearance of an edematous tissue reaction during left atrial linear ablation using intracardiac echo imaging. Circ. 2003;108(11):80. https://doi.org/10.1161/01.Cir.0000083530.08597 .
doi: 10.1161/01.Cir.0000083530.08597
Okada T, Yamada T, Murakami Y, Yoshida N, Ninomiya Y, Shimizu T, Toyama J, Yoshida Y, Ito T, Tsuboi N, et al. Prevalence and severity of left atrial edema detected by electron beam tomography early after pulmonary vein ablation. J Am Coll Cardiol. 2007;49(13):1436–42. https://doi.org/10.1016/j.jacc.2006.10.076 .
doi: 10.1016/j.jacc.2006.10.076
pubmed: 17397672
Wright M, Harks E, Deladi S, Fokkenrood S, Brink R, Belt H, Kolen AF, Rankin D, Stoffregen W, Cockayne DA, et al. Characteristics of radiofrequency catheter ablation lesion formation in real time in vivo using near field ultrasound imaging. JACC: Clin Electrophysiol. 2018;4(8):1062–72. https://doi.org/10.1016/j.jacep.2018.04.002 .
doi: 10.1016/j.jacep.2018.04.002
pubmed: 30139488
Havranek S, Alfredova H, Fingrova Z, Souckova L, Wichterle D. Early and delayed alteration of atrial electrograms around single radiofrequency ablation lesion. Front Cardiovasc Med. 2019;5. https://doi.org/10.3389/fcvm.2018.00190
Jankelson L, Dai M, Bernstein S, Park D, Holmes D, Aizer A, Chinitz L, Barbhaiya C. Quantitative analysis of ablation technique predicts arrhythmia recurrence following atrial fibrillation ablation. Am Heart J. 2020;220:176–83. https://doi.org/10.1016/j.ahj.2019.11.011PMID .
doi: 10.1016/j.ahj.2019.11.011PMID
pubmed: 31835167
Kulstad E, Mercado-Montoya M, Gomez-Bustamante T, Berjano E, Mickelsen S, Daniels J, Hernandez-Arango P, Schieber J: Influence of tissue thickness on thermal latency during high-power short-duration radiofrequency ablation with proactive esophageal cooling. EP Europace. 2022;24(Supplement_1). https://doi.org/10.1093/europace/euac053.085
Kim YG, Boo KY, Choi JI, Choi YY, Choi HY, Roh SY, Shim J, Kim JS, Kim YH. Early recurrence is reliable predictor of late recurrence after radiofrequency catheter ablation of atrial fibrillation. JACC Clinical electrophysiol. 2021;7(3):343–51. https://doi.org/10.1016/j.jacep.2020.09.029 .
doi: 10.1016/j.jacep.2020.09.029
Li Z, Wang S, Hidru TH, Sun Y, Gao L, Yang X, Xia Y. Long atrial fibrillation duration and early recurrence are reliable predictors of late recurrence after radiofrequency catheter ablation. Front Cardiovasc Med. 2022;9:864417. https://doi.org/10.3389/fcvm.2022.864417 .
doi: 10.3389/fcvm.2022.864417
pubmed: 35402564
pmcid: 8990906
Kahle AK, Jungen C, Scherschel K, Alken FA, Meyer C. Relationship between early and late recurrences after catheter ablation for atrial tachycardia in patients with a history of atrial fibrillation. Circ Arrhythm Electrophysiol. 2022;15(6):e010727. https://doi.org/10.1161/circep.121.010727 .
doi: 10.1161/circep.121.010727
pubmed: 35622433
Amankwah NA, Pothineni NVK, Guandalini G, Santangeli P, Schaller R, Supple GE, Deo R, Nazarian S, Lin D, Epstein AE. et al. Impact of atrial fibrillation recurrences during the blanking period following catheter ablation on long-term arrhythmia-free survival: a prospective study with continuous monitoring. J Interv Card Electrophysiol. 2022. https://doi.org/10.1007/s10840-022-01291-0
Levine YC, Ifedili I, Linz D: Atrial fibrillation during the blanking period post ablation correlates with long-term recurrence: myth vs reality. J Interv Card Electrophysiol 2022. https://doi.org/10.1007/s10840-022-01371-1